Bone and Joint Health

Preventing and Treating Runner's Knee

After an unproductive rainy weekend on the couch, you peer out the window and notice the weather has finally brightened. Optimal running conditions are fleeting, so you put on your sneakers for a bit of outdoor therapy. After a quick set of stretches, you start to run for the first time in months, freeing your mind and allowing your spirit to wander. But then, you feel a familiar sensation: The weird combination of aching and burning that can only be runner's knee.

Kneecap Pain

Sound familiar? Runner's knee typically refers to overuse injuries that result in pain around or behind the knee. The three most common classifications are patellofemoral pain (PFP) syndrome, chondromalacia patella, and iliotibial (IT) band syndrome.

PFP is seen most often and is characterized by widespread knee pain or localized pain behind the knee. It originates from the patellofemoral joint, where the patella (kneecap) contacts the femur (thigh bone), and you're most likely to feel it when your knee extends — muscle-lengthening contractions often provoke the pain more than muscle-shortening ones. In other words, you'll have more pain when descending stairs or at foot strike during running than when ascending stairs or pushing off during running. Other telltale signs of runner's knee include crackling or popping, instability, and a sensation of the knee "giving out."

While PFP applies to individuals without cartilage damage, chondromalacia patella is associated with softening of the cartilage located on the underside of the kneecap. Except for this fact, chondromalacia patella and PFP are similar in that both conditions are associated with imperfect kneecap alignment. These improper mechanics can often be attributed to weakness of the hip abductors and external rotators, deficits in knee strength, and quadriceps imbalances. Localized strength training has proven particularly effective in improving pain, according to the Journal of Orthopaedic & Sports Physical Therapy.

IT Band Pain

People with IT band syndrome have pain at the side or sides of the knee. This is unsurprising — the IT band connects the pelvis and hip to the knee, running down both sides of the thigh. Put simply, as the knee flexes during running, the IT band moves from the back to the front of the femur and stabilizes the knee. However, improper running mechanics cause the IT band to rub over the side-to-side movement of the knee joint, leading to inflammation. IT band tightness can also cause kneecap misalignment and is common among individuals with PFP, as well. In addition to using ice to limit inflammation, individuals with IT band syndrome should regularly stretch and use a foam roller.

Whatever type of knee pain you experience, muscular imbalance, tightness, and simple overuse are probably at the root. The key to preventing such injuries is ensuring proper running form. It's imperative to prevent the knees from falling inward or protruding outward, as this will help reduce overload. To achieve proper alignment, work with a physical therapist to focus on stretching your IT band, improving the strength of your hip abductors and external rotators, and doing exercises focused on knee extension. Taking such simple steps will help to optimize your running, treat these nagging injuries, and prevent future pain.

It's important to pace yourself, as well: Build up a running routine slowly and take regular rest days. With the right stretching, treatment, and routine, you can start to take full advantage of those beautiful rays of sunshine rather than solemnly laying on your couch.

Posted in Bone and Joint Health

Dr. Rami Hashish achieved his doctorate of physical therapy from the University of Washington School of Medicine and holds a doctorate in biokinesiology from the University of Southern California. Following his Ph.D. work, Dr. Hashish cofounded a footwear technology startup, JavanScience, which develops customizable footwear to help relieve and prevent foot and leg problems. Dr. Hashish is also active in the clinic, serving as the director of physical therapy for Regenerative Medicine - Pacific Pain & Wellness Group, at Urban Med in downtown Los Angeles.

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*This information is for educational purposes only and does not constitute health care advice. You should always seek the advice of your doctor or physician before making health care decisions.