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Recovery

Everything You Need to Know About Runner’s Knee

From prevention to treatment, experts provide advice on dealing with runner’s knee.

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Runner’s knee is an elusive term thrown around the running community with a knowing look and sense of regret. It’s what every runner dreads and takes newbie and seasoned runners alike with little remorse. It hinders PRs and shatters your running dreams. We all dread it—but what actually is it, and more importantly, how can we avoid it?

What is Runner’s Knee and Who Gets It?

When you’re new to running, or you ramp up mileage too quickly, you can be hit with an all-too-common ailment: the dreaded runner’s knee, or pain and inflammation that occurs around or under your kneecap due to tracking issues with the kneecap that irritate the bony groove it sits in.

It’s different than knee pain that occurs from IT band issues, but runner’s knee can make it really hard to motivate yourself to keep a consistent routine going. (Not to mention, doing so can worsen the inflammation and pain you’re experiencing.)

Runner’s knee is the term often used to describe patellofemoral pain or patellofemoral syndrome.

Runner’s knee causes pain behind or around the patella, which is your knee cap. The pain comes on gradually over time but is often related to an increase in activity that puts extra strain on the knee, such as running, as well as other activities like squatting and climbing stairs. As well as pain, you may have other symptoms such as knee stiffness and clicking or creaking.

Underlying problems can make you more susceptible to developing runner’s knee such as reduced muscle strength (especially in the hip abductors), problems in the alignment of the knee, foot problems, and having hypermobility.

It mainly effects younger adults but can rear it’s head in any age group; in teenagers it’s related to rapid growth, and in older patients can be related to arthritis of the knee.

Luckily, your doctor or physiotherapist can often diagnose runner’s knee without performing any imaging, such as MRI or ultrasound;  the story of your pain along with an examination is usually enough and you’ll only need further investigation if the diagnosis is in doubt.

Treating Runner’s Knee

If you’re experiencing runner’s knee, following the R.I.C.E. (rest, ice, compress, and elevate) method after a run will help to alleviate the symptoms until you can see a professional.

Luckily, runner’s knee has been shown to improve with both physiotherapy and foot orthotics.

Physiotherapy should be started as soon as possible for the best results, and improvement can be expected after 6-12 weeks (if you do the exercises). It aims to improve muscle strength and address any problems in the alignment of the knee.

There’s also some evidence for patellar taping, but this needs to be done by a professional. It’s not advised to give it a go on your own as it’s unlikely to work and could do more harm than good.

Studies have also shown that foot orthotics or insoles can improve symptoms. Again, seeking advice from a podiatrist to make sure you get the right insoles for your feet is the best way to proceed.

Preventing Runner’s Knee

runner-doing-squats
Photo: Getty Images

Avoid increasing your mileage or intensity of your training too quickly.

Not giving your body adequate time to recover can certainly increase your risk of injury. “Most running-related injuries are sustained as a result of overtraining and overuse or failing to adequately recover,” says Jan de Jonge, the author of a recent study published in the International Journal of Environmental Research and Public Health. The study looked at how recreational runner’s attitudes towards the sport related to injuries they sustained over a 12-month period. In the Netherlands, where the study took place, running-related injuries cost their economy approximately $16 million a year in medical costs, time away from work, and reduced productivity.

Include specific strength and conditioning workouts into your training plan.

To truly prevent runner’s knee from occurring in the first place, you’ll need to strengthen and stretch your quads, calves, and hamstrings and incorporate lateral moves that strengthen muscles around your knee joint while improving agility. The fastest way to obtain a running injury is to neglect your cross-training and strength exercises.  You should be cross training and strength training 2 to 3 times per week. Try the following moves and stretches to build a strong base:

Squats

Various types of squats can build strength to prevent runner’s knee. According to physical therapist Mike Riccardi, by varying your positions “it forces you to use your muscles slightly different each time, which trains them more effectively and thoroughly.”

Neutral Squats
Step 1: Stand comfortably with your feet shoulder width apart.
Step 2: Start the motion by sending both your hips and butt down and back.
Step 3: Keep your weight on your heels.
Step 4: Make sure your chest stays up with your head facing forward.
Step 5: Return to standing.
Do 2-3 sets of 10 reps each.

Wide Squats
Step 1: Stand comfortably with your feet slightly wider than shoulder width apart; toes turned out.
Step 2: Start the motion by sending both your hips and butt down and back.
Step 3: Keep your weight on your heels.
Step 4: Make sure your chest stays up with your head facing forward.
Step 5: Return to standing.
Do 2-3 sets of 10 reps each.

Staggered Squats
Step 1: Stand comfortably with shoulder width apart. Then take one small step forward.
Step 2: Keep your heels planted and start the motion by sending your hips and butt back and down.
Step 3: Keep your weight on your heels.
Step 4: Make sure your chest stays up with your head facing forward.
Step 5: Return to standing.
Do 2-3 sets of 10 reps, switching feet halfway through.

Narrow Squats
Step 1: Stand comfortably with your feet slightly apart.
Step 2: Start the motion by sending your hips and butt back and down.
Step 3: Keep your weight on your heels.
Step 4: Try to keep your knees separated throughout the squat.
Step 5: Make sure your chest stays up and with head facing forward.
Step 6: Return to standing.

Wall sits

You can’t go wrong with a wall sit—you can do them almost anywhere, and they are extremely effective for helping you strengthen your quads.

Step 1: Stand with your back against a wall, placing your feet about two feet out in front of you. Feet should be hip-distance apart.
Step 2: Bending your knees, slide your back down the wall until your knees are at 90-degree angles. Your knee joints should be over your ankle joints, so you may need to inch your feet farther from the wall to create proper alignment. Your thighs should remain parallel.
Step 3: Hold for 30 to 60 seconds, and then stand up. Repeat for a total of three reps.

To make this move more challenging, alternate between lifting your left heel for a few seconds and then your right. This helps to target your calves.

Lateral lunges

Many people neglect their side muscles, which can mean that the muscles surrounding your knee joint can be weakened. Incorporate lateral work into your routine so you help strengthen those muscles. Try doing alternating side lunges to strengthen all areas of your butt, hips, and thighs.

Step 1: Start with your feet directly under your hips. Step your right foot wide to the side coming into a lunge with your left fingers touching your right foot. Your right knee shouldn’t go beyond your right toes. Keep your chest lifted and your weight in your heels.
Step 2: Push into your right foot to return to standing, then lunge sideways to the left to complete one rep.

Hamstring stretch

Weak quads and tight hamstrings can be a recipe for disaster when it comes to your knees. Loosen up hamstrings and shoulders with this tip-over tuck hamstring stretch:

Step 1: Stand with your feet hip-width distance apart. Interlace your hands behind your back. Keeping your legs straight, bend at the hips, tucking your chin and bringing your hands over your head.

Step 2: Relax the back of your neck, and if the stretch is too intense, then release your hands, placing them on the backs of your thighs, and soften your knees. Hold for 30 seconds, and slowly roll up to standing.

Calf stretch

Making sure your calves stay stretched and loosened will help alleviate runner’s knee. Try this classic calf stretch against a wall.

Step 1: Stand a little less than arm’s distance from the wall.
Step 2: Step your left leg forward and your right leg back, keeping your feet parallel.
Step 3: Bend your left knee and press through your right heel.
Step 4: Hold for 20 to 30 seconds and switch legs.

Seek professional help earlier rather than later if you have any concerns.

Runners are notorious for not listening to their bodies. There are various causes of knee pain in runners beyond just runner’s knee. It’s always best to seek the help of a medical professional to assess the cause of your pain.