Knee pain in runners: the 2 most common causes

Knee pain running is common. With the marathons in London and Brighton we’ve seen an increase in people coming into our clinics with knee pain associated with running. The 2 most common causes of knee pain in runners are “Runners knee” and ITB syndrome. In this posting we’ll talk about runners knee pain, what it is and how to treat it. Next we’ll do the same for ITB syndrome.

Runners knee

“Runners knee pain” is more correctly termed patella femoral syndrome and can affect as many as 1 in 4 runners. The symptoms are typically pain under the knee cap and around the front of the knee and used to be called chondromalacia patella.

Anything where the leg is bending and straightening can become painful, particularly when weight bearing, and there may be creaking or cracking under the knee cap, a symptom termed crepitus. Of course running, particularly once milage when training for a longer distance event is increased is a common cause. Aggravating factors also include going up and down stairs, running, in particular up or down hill, leg extensions/quad strengthening in the gym, often sitting for a prolonged times at work or in the car for instance.

Cause of Runners Knee Pain

The causes of runners knee are related to the anatomy of the area. The underside of the patella (kneecap) has a ridge which slides along a narrow groove in the femur (thigh bone). Every time you bend and straighten your knee the patella slides up and down the groove. Trouble can start when your kneecap moves out of its track or groove and rubs up against its sides causing friction. This is called patella misalignment or maltracking. That it becomes painful when you run is not surprising when you realise that there are on average nearly 1000 steps per mile.

Common things that can cause misalignment and how to fix them are:

  • Quadriceps imbalance: This is perhaps the most common cause of runner’s knee. The quadriceps muscle on the front of the thigh is made up of four parts and running strengthens the outer part more than the middle part, thus the patella is pulled out of alignment. This usually resolved with some specific rebalancing exercises for the muscle group.
  • Foot instability: Often your feet imbalanced every time they hit the ground, and you’re feeling the constant pounding and repetition of this mistake in your knee. Over pronating, which means your foot is rolling in too much when you run, is the most common type of this, something that is often associated with fallen foot arches. A combination of orthotics (these are special insoles; at Sundial we use Superfeet orthotics) for your running shoe and exercises is usually enough to rebalance and stabilise the foot. You should also have your running analysed to make sure your shoe is the suitable for you. For more on orthotics and running go here.
  • Tight muscles at the back of the calf or thigh: If the calf muscles are tight the foot will have to pronate further when running or walking causing an increase in rotation at the lower leg bones, if the hamstrings are tight when running or walking the knee is not fully straightened, this also means the foot has to roll more into pronation. Both of these can cause patella misalignment and are treated with specific stretches and rebalancing exercises.
  • Gluteus medius weakness: One of the muscles that make up the buttock, it often relatively weak in runners. If the gluteus medius is not strong enough the upper leg rotates inwards and causes an unequal pull of the patella over its groove. Again, some specific strengthening and stretching exercises usually resolve this.

In addition to the specific treatments for each cause there are a few other things which also help resolve runners knee.

  • Ice: Wrap a cold packs around each knee, with the pack at the front for about ten minutes, a few times a day to bring down the swelling. Make sure the cold pack is wrapped in a thin cover to avoid cold burns!
  • Rest: Not what a runner wants to hear close to an event, but where possible, stopping or decreasing your running will help then problem settle whilst treatment takes effect.
  • Laser treatment: This is useful in reducing the inflammation around the patella and encouraging faster healing
  • Taping: Specific taping techniques, particularly kinesio or Rock taping, something our physio Quentin specialises in, can help straighten the pull of the patella
  • Running/gait analysis: Many running shoe shops offer this and it’s a good way of screening your running for problems and also seeing if your shoes are suitable for you

If you would like a check to see if you have runners knee then call us for our free Runners MOT with our physios or chiropractors.


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