Running with Runners’ Knee

Whether you are an ultramarathoner or a weekend warrior who enjoys casual runs, you most likely run into knee-related pain. Knee pain is one of the most common running-related injuries and affects about 55% of recreational runners. There are many different causes of knee pain or knee-related injuries, few of the most common knee injuries include patellar tendonitis, patellofemoral pain, iliotibial band pain, and strains/sprains.

What Is Runners’ Knee?

Runners' knee or patellofemoral pain is the most prevalent of injuries listed. Patellofemoral pain is pain in the front of the knee and around the kneecap due to cartilage damage. It is typically an overuse injury with more than one cause with atypical running mechanics being one of the crucial risk factors. 

Patellofemoral pain is one of the most common running-related knee injuries affecting 20-22 percent of runners. 

Runners’ Knee Causes

Many causes of runners' knees are often multifactorial. One of the biggest regions that affect the mechanisms related to patellofemoral pain is the hip. The compensations we typically see associated with patellofemoral pain due to muscle imbalances or structural abnormalities include increased hip adduction (knee falls more toward the midline), hip internal rotation (the leg is typically rotated inward to a degree), and contralateral pelvic drop (the side of the pelvis opposite the stance leg drops). 

What Research Say

The American Journal of Sports Medicine recently published an article on the subject that offered an effective solution to those struggling with patellofemoral pain. The study followed 33 participants with patellofemoral pain over 3 months. The researchers had the participants increase their cadence (steps per minute) by 10% and check in with them at 4 weeks and 3 months. 

All participants experienced a reduction in pain and improved biomechanical function while running. The average pain rating of the participants at the beginning of the study was 6.2 on a scale of 0-10, with 0 being no pain and 10 being the worst pain. At 4 weeks that average dropped to 1 out of 10 and at 3 months, the average pain had decreased to .3 out of 10. All participants displayed statistically significant improvements in the three functional deficits listed earlier (increased hip adduction, hip internal rotation, and contralateral hip drop).

If you are experiencing patellofemoral pain, this is a good place to start. You can always increase your cadence by about 10%, decrease your mileage, or try adding in another cardio activity such as rowing, biking, or swimming that decreases the compressive load on the knee.

Patellofemoral Pain Leading to Patellar Tendonitis

Patellar tendonitis is another overuse injury that is defined by the pain in the tendon that connects the kneecap to the tibia (the shin bone). Many of the things that cause patellofemoral pain can also lead to patellar tendonitis. The first thing to do when this pain presents is to rest, decrease mileage, or modify your activities to those that decrease the strain on the patellar tendon. 

Exercise Treatment for Patellar Tendonitis

Treatment options outside of those just mentioned include therapeutic exercise, ice, Class 4 laser therapy, dry needling, ultrasound therapy, and many more. A few exercises you can try if you start experiencing this type of pain include wall sits, slow squats, or “sissy” squats. Some general quad stretches or foam rolling will help decrease the tension on the patellar tendon and should help relieve some of the symptoms.

Iliotibial band pain is also common with runners. 

Iliotibial Band

The iliotibial band is an extremely strong piece of connective tissue to which the gluteus Maximus and tensor fascia lata attach. 

Many of us spend our time trying to foam roll the outer thigh only to discover no change in the discomfort or tension we are experiencing. That’s because, no matter how much we massage or pound on that band of connective tissue, there will be no change in our symptoms unless we decrease tension in the muscles that act upon it. 

Exercise to Treat Iliotibial Band

The areas you want to focus on massaging or foam rolling are the glutes and the TFL muscles. The pigeon stretch is great for loosening the glute muscles and the lying abductor stretch is great for loosening the TFL muscle. If the foam roller doesn’t seem to be cutting it on these muscles, you can always use a lacrosse ball to dig in for a more intense muscle release.

Get Relief from Runner’s Knee

As stated previously, there are many causes of knee pain associated with running. If you find yourself experiencing any of these symptoms, try adding in the exercises or exercise modifications. If the symptoms persist, consider reaching out to a healthcare professional.

Knoxville Spine and Sports offers quality chiropractic care and physical therapy to help you with runners’ knee pain relief. Make running fun again!