Runner’s Knee

Runner’s knee is a general term for pain around the kneecap or patella. Symptoms in this region vary widely from being a low-grade annoyance to complete inability to run. The cause is also somewhat unknown.Some theorize that a misalignment of the patella due to body mechanics or strength and flexibility imbalances is the culprit resulting in abnormal strain on the back of the kneecap. Treatments such as knee braces or taping to change the position of the patella have emerged to minimize the misalignment. These treatments do seem to improve knee function, however, MRIs performed while tape is applied has not shown a change in the position of the kneecap. Additionally, the model that the back of the kneecap is the source of the pain is questionable since there are very few, if any pain receptors in this area. Some have hypothesized that the tissue that lines the knee joint (synovium), which is adjacent to the patella, is the source of the pain since it does have large amounts of pain receptors. Knee pain according to this model would be similar to biting your cheek. It is not the teeth that hurt but the lining of the mouth, and once the lining is irritated it swells and becomes more likely to be pinched again. Braces and taping may alter the position of the synovium so that it doesn’t get pinched as much or as frequently. Improving mechanics as well as strength or flexibility imbalances would also limit strain on this tissue.

Treatments:

• See Principles of Recovery.
• Recent research has shown good results with strengthening of the gluteal muscles. The theory is that strengthening the gluteal muscles may help reduce strain at the knees. I have treated several runners with knee pain by only having them strengthen the gluteal muscles and have been amazed at the improvement. These exercises are part of the program presented in The Injured Runner – A Balanced Solution.
• An extremely simple exercise known as “quadricep setting” can also be very effective. This exercise seems too simple to have any effect; however, it is definitely worth trying. With your leg out straight while in a seated position, tighten the thigh (quadriceps) muscle as firmly as you can. Sometimes a rolled up hand towel behind the knee will make it less painful. You should sense your kneecap sliding towards you as you tighten, if not keep trying until you get it. Hold the contraction for three to five seconds and repeat twenty times, three times per day. Try this for a couple of weeks and you should notice a distinct improvement.
• Stretching is often helpful for runner’s knee. Give extra attention to the hamstrings, calf muscles and quadriceps. See hamstring stretch, bent knee calf stretches, straight knee calf stretches and quadriceps stretch.
• Arch supports , or orthotics (custom foot supports) may be able to support the foot in a way that reduces strain on the knee.
• A knee brace that has a cut out for the kneecap and a way to adjust pressure on the kneecap can be helpful. Most runners also prefer a cut out region in the back of the brace. Adjust the pull on the kneecap until you find a position that cuts down your pain when you run. You should start by adjusting the brace to pull the kneecap inward, then try inward and upward or inward and downward. I have even had some patients that prefer the brace to pull the kneecap outward. If the brace is going to help, you should notice some improvement immediately. Try not to wear the brace all day. It will probably be more beneficial if it is worn when you are more active.
• A physical therapist can perform an evaluation to specifically assess strength, flexibility, balance, etc and design an appropriate program for you. They may also try taping techniques that can provide more specific pressure around the kneecap.
• Glucosamine has become popular in the management of knee arthritis. In my experience it can also help for “Runner’s Knee”. The recommended dosage is 1500 mg per day. Currently there are no known side effects and some indication that it may slow cartilage degeneration. In my opinion it is definitely worth trying.
• An anti-inflammatory cream may help reduce the pain and inflammation. ProZ is a new product that contains ibuprofen as well as a blend of homeopathic remedies.
• The “Pose Method” of Running may help reduce knee pain. This is a specific running technique that emphasizes landing on the forefoot with the knee flexed and a shorter stride length. Preliminary research has demonstrated decreased loading of the knee with this style of running. Changing a person’s style of running is controversial but if your knee is hurting you may want to consider this approach. You can find more information at posetech.com.