Runner’s knee, defined as anterior knee pain, is prevalent in athletes. Fortunately, there are several effective strategies for reducing the pain and eliminating the source of the problem.
Runner’s knee is defined as anterior knee pain that is exacerbated by physical activity. Aside from the pain, other symptoms include swelling and reduced patellar mobility. As its name suggests, runner’s knee is common in runners, but it is also prevalent in the general population; runner’s knee is responsible for up to 25% of all knee injuries. Interestingly, runner’s knee is two times more prevalent in females than their male counterparts. The formal medical term for runner’s knee is patellofemoral pain syndrome. A comprehensive review of patellofemoral pain syndrome and other knee injuries was published in a primary care journal last year (Meniscal, Plica, Patellar and Patellofemoral Injuries of the Knee, 2013. Morelli V and Braxton TM).
Runner’s knee is caused by a variety of related factors that ultimately result in patellar misalignment, friction and/or inflammation. The patella, also known as the kneecap, is a small triangular bone at the knee joint. When the muscles that hold the patella in place become imbalanced, the patella may track laterally. The muscle pull on the patella may become imbalanced due to tightness, weakness or strength. When the patella tracks out of place, the patella grinds into cartilage on the femur producing the inflammation and pain characteristic of runner’s knee. Additional causes of runner’s knee may include flat feet, which causes stress on the achilles tendon that gets transmitted up to the knee, or a direct blow to the knee.
Runner’s knee, once contracted, requires treatment. One study found that 94% of patients with untreated runners knee were unable to alleviate symptoms after 4 years, and the symptoms were still present in 25% of patients 20 years later. Many of the treatments are easy to follow remedies prescribed on WebMD. Some methods of reducing the inflammation include icing the knee, elevating the knee, compressing the knee and taking anti-inflammatory pain killers. Furthermore, resting the knee would alleviate friction and, if prolonged, possible reduce the muscle imbalance. These solutions would relieve the pain and inflammation symptoms of runner’s knee. However, these would be quick-fixes and not necessarily solutions for the source of the problem: patellar misalignment.
There are several non-operative treatments for runner’s knee that have been found to have long term success. For athlete’s who are flat footed, a treatment is using arch support to help ease the strain on the achilles tendon. Foot orthotics was found by one study to significantly improve 80% of patients with runner’s knee. Stretching can reduce muscle tightness and balance out the forces pulling on the patella. Focus on the iliotibial band (commonly referred to as the IT band), which runs laterally from the hip to the knee. A stretch for the IT band can be seen in the figure on the right. Taping methods can help realign the patella and relieve pressure on the femur cartilage. One study found Kinesio taping to be ineffective, while McConnell taping was effective in 66% of patients, particularly those with a low BMI. Knee braces and sleeves have been shown to be effective strategies of eliminating runner’s knee. Finally, physical therapy has been found by some studies to reduce pain up to 90%. These treatments, both individually and combined with one another, have been found to significantly improve most patients with runner’s knee. Nonetheless, surgery may be required as a last resort. Surgical treatments for runner’s knee remove damaged cartilage on the femur.
Runner’s knee will persist for years if left untreated. However, there are several easy remedies that can both remove the pain and realign the patella (the source of runner’s knee). Just like tomorrow’s workout, runner’s knee is manageable!