Also known as Patellofemoral Pain Syndrome, Runner’s knee is a broad term for pain in the front, around or behind the knee cap.
As the name suggests, running is a common cause of runner’s knee, but any activity that puts repeated stress on the knee joint can cause this disorder. The list includes walking, skiing, biking, hiking, jumping to name a few. It affects 10-15 % of all runners at some point of time.
What causes Runner’s Knee?
Unlike other sports injuries, there is no actual damage associated with Runner’s knee initially. It is mostly an overuse injury cause by repeated stress on the knee. This repeated stress causes inflammation of the tissues around the knee cap especially fat, bursal and synovial tissue. In normal conditions, these tissues provide joint lubrication and cushioning to the knee but in inflammation, they become painful.
Some risk factors for the development of Runner’s knee include:
- Overuse – Activities/Exercises that bend the knees repeatedly is one of the common causes. It can also be caused by sudden change in physical activity such as increasing the number of days you exercise in a week or increasing the duration or intensity of the activity.
- Problems with the feet – Flat foot, hypermobile feet (joints in the feet move more than they should) or foot hyperpronation (foot rolls inwards when you walk) change the way you walk altering the biomechanics, leading to knee pain.
- Patellar Malalignment – In this condition, the patella (knee cap) moves abnormally in the trochlear groove (femur bone). When the knee is bent, the patella is pushed to one side of the groove which causes increase in pressure between the patella and the groove.
- Unbalanced Quadriceps – The patella bone is the continuation of the quadriceps muscle in front of your thigh. Any weakness or tightness of the quadriceps will not let the patella move in the right spots causing higher stress and pain.
- Chondromalacia Patella – It is a condition in which the cartilage of the patella softens and starts to break down. Since the cartilage does not have any nerves so the cartilage damage does not directly cause any pain. However, it leads to inflammation of the synovium which causes pain. In advanced cases when full thickness cartilage loss occurs in a part of the bone, rubbing of the bone with another surface causes pain.
Symptoms
- The most common symptom is a dull pain in or around the front of the knee. It generally begins gradually and keeps on increasing as the activity increases. It can be associated with a lot of activities apart from running like walking, squatting, kneeling, climbing or descending stairs.
- Pain increased/started after increasing exercises or increasing the intensity of exercises.
- Pain in front of the knee after sitting for a long period of time with your knees bent.
- Some patients can also complain of swelling of the knee.
- Crackling sounds is also heard from the knees of some people.
How to manage a Runner’s Knee?
Most people with Runner’s knee can be effectively managed at home.
The first step in the management of Runner’s knee is to stop the activities that hurt your knee. The activities should be discontinued until your pain is resolved. You can also change your training routine to low-impact activities such ac cycling, swimming which puts less stress on your knees.
The initial treatment consists of RICE protocol.
Rest – Avoidance of activity causing pain.
Ice – Apply ice packs to the knee and adjoining part for 10-15 minutes at a time, several times in a day.
Compression – Apple compressive elastic bandage to the knee from leg to thigh to prevent development of additional swelling in the knee. Be careful that the bandage is not too tight.
Elevation – Keep your leg on an elevated level while sitting and lying down. This helps reduce swelling in the knee.
Medications – You can take an Over-the-counter (OTC) non-steroidal anti-inflammatory drug (NSAID) such as diclofenac, ibuprofen to reduce the pain and swelling.
If your pain and swelling doesn’t improve or gets worse, you need to consult an orthopedician immediately.
6 Tips to prevent Runner’s Knee
1. Doing warm up before physical activity.
2. Quadriceps and hamstring muscles should be stretched and made flexible in your warm ups.
3. If you’re overweight, you need to loose the extra kilos to maintain your overall health.
4. Use proper shoes for training.
5. Always increase the intensity and duration of your training/physical activity gradually. This makes your body adjust to the increased stress and decreases the chance of injury.
6. Avoid activities involving deep squatting, hopping, repetitive stair climbing.
10 Exercises for Runner’s Knee
1. Straight Leg Lift
Lie down flat on your back with one knee bent and the other leg extended straight on the floor.
In the straight leg, tighten the quadriceps (thigh muscle) and raise it to about 45 degrees to the floor.
Hold at this angle for 2-3 seconds and then slowly lower it to the ground.
Repeat 15 times and switch legs.
2. Hamstring stretch
Lie down flat on your back.
Bend your right leg and put your hands around your right thigh.
Start pulling your leg towards you. As you pull you will feel a stretch in the back of your thigh.
Pull as much as possible with your knee straight.
Hold for 15 seconds.
Repeat 3-5 times for each leg.
3. Clam Exercise
Lie on your side with both your hips and knees bent and your feet on top of each other.
Slowly raise the top leg towards the ceiling with your heels touching each other, thus forming a clam shape.
Hold for 2 seconds then lower the leg.
Repeat 15 times. Switch legs.
Do 2-3 sets for each leg.
4. Side Lying Leg Lift
Lie on your left side with your legs straight and on top of each other.
Support your head with your left hand and use your right hand for body support.
Gently raise your right leg off your left leg.
Hold for a few seconds and bring it down.
Do 15 times for each leg.
5. Donkey Kick
Start on all 4 with your arms straight with wrists under the shoulders and knees under the hips.
Slowly lift your left leg backwards till the hip height keeping your ankle bent.
Push your heel towards the ceiling then bring it back down.
Straighten your leg, hold for 2 seconds then lower it back down.
Repeat 10 times then switch sides.
6. Standing Quad Stretch
Stand straight.
Bend your right knee and grab your right foot with your right hand behind your body.
Bring your right heel as close to your glutes as possible without causing pain. Keep your body upright. Take support if needed.
Hold for 10-15 seconds. Repeat for other side.
Perform 2-3 times for each side.
7. IT Band Stretch
Stand with your left leg crossed over your right.
Raise your right hand over your head and keep your left hand over your left thigh for support.
Slowly lean towards the left until you feel a stretch in your right thigh.
Hold for 15 seconds and repeat for the other side.
Repeat 3-5 times.
8. Standing Calf Stretch
Stand facing a wall. Put your hands on the wall at your eye level.
Move one leg forward with the knee bent.
Keeping both the heels fixed on the ground move lean the wall until you feel a stretch in the calf muscles of your back leg.
Hold for 15 seconds and switch legs.
Repeat 3-5 times.
9. Step Up
Place your left foot on a step.
Put all your weight on your left leg lifting your right leg off the floor.
Straighten and tighten your left leg and hold for a few seconds.
Repeat 10 times, then switch legs.
10. Wall Slide
Begin by standing with your back against the wall. Your feet should be shoulder-width apart and about 6 inch in front of your body.
Slowly slide your back and hips down the wall until your knees are bent to about 45 degrees.
Hold for about 5 seconds, then stand up.
Repeat 10-15 times.
DISCLAIMER
Discontinue the exercises if your pain increases. These exercises should ideally be done after consulting a doctor.