Runner’s knee is an umbrella for various conditions that cause pain around your kneecap. These conditions include anterior knee pain syndrome, patellofemoral malalignment, chondromalacia patella and iliotibial band syndrome (ITB). As the name suggests, running is the most common cause of this kind of knee pain, but it is also quite common in non-athletes. Almost 25% of the world’s population have some form of knee pain, more specifically pain in the area of the kneecap.

The anatomy around your patella

Patella (kneecap)

Femur (thigh bone)

Tibia (shin bone)

Quadriceps muscle

Runners Knee, Knee pain While running

What should happen in and around my knee when I move?

Now I have runner’s knee. What went wrong?

The strain put on the patella causes a compression in the femoral Groove. The higher the load on the quadriceps the greater the compression on the patella. The excessive pull on the quadriceps tendon on the top part of the patella can start tearing the tendon fibers. The downwards compression of the back part of the patella onto the femur will over time erode the cartridge and reduces its shock-absorbing function. This compression force is exacerbated when the quadricep muscle is shortened. If the quadriceps muscles are weak it could cause a sideways pull on the patella that can cause the patella to run towards the in or outside that may run down the cartilage much faster.

There are many theories that proposes that a runner’s knee is an result of a bigger bio-mechanical problem. We have found this to be true in practise.

Causes of runner’s knee

  • Over use (bending or heavy lifting activities)
  • Trauma to the knee cap
  • Misalignment of the knee cap due to weak quadricep muscles
  • Complete or partial dislocation of the Patella
  • Tight thigh muscles including the quadriceps and hamstrings
  • Inadequate muscle length of the quadriceps muscles
  • Arthritis

Symptoms of runner’s knee

A Dull ache around or behind the knee cap (Patella)
Pain especially over the quadriceps insertion on to the top of the patella or the lower part of the thigh bone
You will be able to elicit the pain when walking, running
Standing and bending both knees like when doing a squat
Direct pressure will be painful like when kneeling on the knee
The pain will be worse when walking down stairs or descending a hill
Swelling may be present
Pain after sitting for a long time with the knees bent
Popping or grinding sensation in the knee

Mild

  • Deep, dull ache in your
  • Sharp sting, Electrical, shock
  • Tender over the side
  • No bruising
  • Certain positions produces expected pain
  • Stiffness in your
  • Pain at the end of a movement (at the end of straightening or bending your knee)
  • Able to pinpoint the pain to the front of your
  • Still able to walk without pain
  • Pain comes & goes
  • Stiffness in your thigh
  • Slightly swollen
  • Pain goes away when you rest
  • A single point of pain
  • Getting up after sitting for a long time gives you pain
  • Activity (Bending down to tie shoes) feel harder than usual
  • Cramping of muscles around your

Moderate

  • Sharp, cramping lower back pain
  • Stabbing pain with a sudden movement
  • Stiffness when turning over in bed
  • Painful to get up in the morning
  • Spasms doesn’t ease with rest
  • It takes a while for you to straighten your back after getting up
  • Putting on pants and shoes worsens your pain
  • Unable to walk without pain
  • Back feels weak
  • Too painful to play physical games with your kids
  • Sitting for a long time becomes unbearable
  • Heat helps to relieve the pain for a while
  • Gentle stretches ease the pain, but doesn’t take it away
  • Limited range of movement.
  • You can’t move (your neck or head) as far as you could before.
  • Or being stuck in a certain position – unable to turn your spine
    Swelling and bruising around the knee joint (Immediate)
  • Pain through the whole range of movement
  • “Unstable” on your leg
  • Pain worse when taking weight on the affected leg
  • Twisting movements increase pain
  • Fearful to balance on one leg
  • Climbing stairs with difficulty

Serious

  • Constant pain
  • Excruciatingly sharp pain
  • Pain spreading from your lower back to your buttocks
  • Stabbing, burning pain when you turn too suddenly
  • Pins and needles down your leg
  • Your legs feel weak and wobbly when you get up
  • Lower back feels ‘locked’ when you try to to stand up
  • Pain worse at night
  • Can’t find a comfortable position to sleep in
  • Sneezing or coughing sends your pain through the roof
  • Impossible to bend forward
  • Your back feels stuck in one position
  • Need help to put on pants
  • Too painful to drive
  • Unable to exercise
  • Tingling feeling running down the arm/leg
  • Audible Pop or crack
  • Severe and immediate swelling and bruising visible around
  • Sharp pains when trying to bend or straighten
  • Knee feels ‘locked’ – Unable to move the knee fully
  • Knee feels very unstable
  • Knee buckles underneath you
  • Cannot stand on one leg
  • Unable to climb stairs

Tests that you can do to see if you have runner’s knee

  • Sit upright on a chair
  • Slowly lean forward as if to reach down to put on your shoes
  • Come back up into an upright seated position
  • Pain and tension in your lower back at any point during these movements may indicate that you have muscle pain and spasms in your lower back

  • Stand comfortably with your feet slightly apart and arms hanging next to your sides
  • Bend sideways to one side
  • Slowly bend as far as you can go and come back up
  • Repeat this movement to the other side
  • Pain or tension in your lower back at any point during this movement may indicate a muscle pain and spasms in your lower back

  • Stand comfortably with your feet slightly apart and your arms next to your sides
  • Turn your upper body to one side as far as you can go (almost like you want to reach the back of your leg with your hand)
  • Repeat this movement to the other side
  • Pain or tension in your lower back may indicate muscle pain and spasms in your lower back

  • Stand comfortably with your feet slightly apart
  • Try to tilt your pelvis back, flattening your lower back
  • Keep your lower back and the rest of your back as flat and straight as possible while slowly bending forward
  • Bend as far as you can and come back up, while keeping your back as flat and as straight as possible
  • If you feel pain or tension in your lower back or even an inability to control the movement, you could have muscle pain and spasms in your lower back

I have runner’s knee – how bad is it?

Diagnosis

Physiotherapy diagnosis

A physiotherapist can confirm the diagnosis by taking a complete history and physical examination. In some cases it may be necessary to take X-rays or a MRI to see the patella’s position when your knee is straight and bent.

X-rays

Muscles cannot be seen on an x-ray, so it will not be effective to diagnose a muscle spasm. X-rays will however show the integrity and alignment of joints in your spine. This will enable us to see if something is wrong with the structure of the bones in your spine or if there is a loss of disc space.

What are you looking for on an X-ray? Cortical stress lines, Displacement measurements, What Classification is done via X-ray?

Your physiotherapist can refer you to get x-rays taken if necessary.

Diagnostic ultrasound

Diagnostic ultrasound can be used to show the presence of a muscle tear (muscle strains), inflammation, swelling or simply increased contraction of a muscle (muscle spasms).

If you need an ultrasound, your physio will refer you.

MRI

An MRI scan can image all of the structures in your lower back, including soft tissue, discs, nerves and bones. However, for a muscle spasm an image like this is unnecessary and very expensive. If your physiotherapist suspects anything more than just a muscle spasm, you will be referred to the right specialist.

Is an MRI necessary for this diagnosis – if not when could it become a necessity?

Why is my knee pain not going away?

What NOT to do

  • Continuous use of anti-inflammatory medication, as they are thought to delay healing

  • Manage the pain by only taking pain medication or muscle relaxants. You are only masking the symptoms of something more serious

  • Stretch through the pain

  • Walk, run, jog through the pain

  • Do not ignore back pain that gets worse (it could be an sign of a deeper problem)

  • Leave it untreated, if you are uncertain of the diagnosis, rather call us and be safe

What you SHOULD do

  • Rest as needed

  • Avoid activities that is flaring up your pain, like sitting for long hours or bending

  • Make a list of movement or activities that brings on your pain and rank them

  • Make an appointment to confirm the diagnosis and determine how severe the tissue damage is.

  • Finish your treatment and rehabilitation programme for better long-term results

Making it worse

  • Specific movements, positions or even sports that we know will definitely make it worse. Just mention the top culprits.

  • Bending down to tie shoelaces

  • Picking up your child

  • Climbing stairs

  • Walking uphill

  • Running

  • Deadlifts

  • Jumping

  • Wearing high heels

  • Driving

  • Working at your computer

Problems we see when patients come to us with runner’s knee

Physiotherapy treatment

Physiotherapists aim to identify the core structures that is contributing to your pain. We use a variety of techniques to desensitize the irritation on the soft tissue that includes exercises to modify.

Remember prevention is better than cure. Speak to The Experts in the field and let us guide you through the process.
Don’t run on your knees if you know you could be over weight
Stretch your quadriceps after every run.
Gradually increase your training intensity and distance
We recommend sticking to the 10% rule. Increase only one of your parameters less than 10% per week. (Time/ Distance/ Pace)
Foam roll your quadriceps, hamstrings and calf muscles.
Make sure you’re running in the correct shoes specifically for your body

Phases of rehabilitation

Should I do squats to fix my runner’s knee?
Although squats are fantastic for building all-over leg strength, these are not great for when you’re experiencing knee pain because they require deep bends of the knee. Instead of bending your knees to start the squad, imagine you’re sitting down in a chair. This causes you to push your hips and upper body back first, releasing some of the tension on your knees. When your thighs are parallel to the floor, make sure your weight is over your heels rather than your toes.

What about lunges?
This is another one you shouldn’t attempt when experiencing knee pain, but should include when you are not in pain. Be sure to keep your core engaged and as you step forward, try to think of your hips moving down towards the floor rather than forwards. Your knee may not go over the line of your toes. Try doing it against a wall until you’re comfortable.’

1st Phase


2nd Phase


3rd Phase


4th Phase


5th Phase


    6th Phase


    Can I still run if I have runner’s knee?

    It’s safer to consult a physiotherapists opinion to accurately diagnose the problem. The sooner you decrease the irritation on the knee, the faster the healing will begin. At the first sign of pain cut back on your mileage and rather focus on interval training. Avoid any speed or paste training that requires fast acceleration and deceleration. No Hill or decline runs, it would be safer to run on the treadmill until the knee pain has dissipated. You must include a stretching program at the end of your run which includes quadriceps, hamstrings and calf muscles. Foam roll for an even better results.

    Other forms of treatment

    • Your doctor (GP)
    • Pain meds, injections
    • Chiropractic
    • Knee brace
    • A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your sport.
    • Stretching or foam-rolling

    Is surgery an option?

    What else could it be?

    Also known as

    • Jogger’s knee
    • Chondromalacia patella
    • Maltracking of patella
    • Anterior knee pain
    • Patellofemoral pain syndrome
    • Kneecap pain