The runner's knee gets its name from its degradative history, creating common pain for running participants. Runner's knee more specifically is known as Patello-Femoral Pain Syndrome which presents as a constant dull or agonising pain at the patella (knee cap). It can be one of those long-term nagging injuries which over time can seriously disrupt an athlete's load management and running gait which may then cause further problems throughout the body. What may start as a dull pain at the front of the knee, may soon travel to an athlete's hips or lower back as they try to avoid the pain during runs and compensate through other muscles.
So what can we do about it?
Runner's knee can be due to a combination of many different factors. It is common to find that runners' knees may be associated in an athlete with a strength deficiency between limbs, or between the muscle balance of the hamstrings and quads on the affected leg. Whilst anatomical/genetic causes like an overly high knee cap or excessively tight Illiotibial band can be the cause of such pain, typically there is a strength, mobility or movement dysfunction which is causing the underlying problem. Easy tests you can do at home include a single leg hamstring raise and a knee-to-wall test. These exercises will test the mobility of the hamstrings and ankle joints. Two common points of dysfunction with Patellofemoral Pain Syndrome. A single leg raise below 90 degrees or a knee-to-wall score under 9cm’s may indicate an area of tension causing problems. A test over 10-20% in the difference between sides may also indicate an asymmetrical indicator of an underlying cause.
The most important aspect of fixing your runner's knee pain is to release tight musculature and strengthen their opposing weak muscles. Typically, releasing tight hamstrings and strengthening the antagonistic quadricep will create more aligned push: pull forces on the knee and decrease sensations of pain. Stretching and triggering through the glute max and TFL muscles will decrease the tension on the ITB, decreasing the pull on the lateral knee. Strengthening through Glute medius, Hip Flexors and Adductor muscle groups will improve the opposing strength deficits caused by a tight Glute Max (extensors) and TFL (Internal rotators). Below the knee, improving ankle mobility, Calf length and strengthening the Tibialis Anterior may also prove beneficial for fixing runners' knee. These combinations create the perfect balance of push and pull strength, above, below, medially and laterally to the knee joint.
Factors such as your running mechanics will also play a pivotal role in decreasing the tension on the knee. Pronated foot collapse, lateral foot displacement upon impact, foot/ground contact position, Q angles, stride length and knee flexion/extension through the gait cycle are all potential factors for injury concern. This is completely individual to the athlete. An Allied health professional such as a Physiotherapist and or Exercise Physiologist will be able to see movement dysfunctions during your running gait which will assist in creating a tailored plan for returning to running pain-free. A quick and easy tip when experiencing runner's knee is to attempt shortening your stride length when running. This may potentially decrease the load per stride and assist in the short term whilst you maintain attention on strength and postural deficiencies. Please note, that this is only general advice and all athletes should be screened by an Allied Health Professional before attempting to run with persistent pain.
Managing your running load
The run load may be one of the most crucial factors to fixing or preventing runner's knee pain. A large spike in run load within a short time period is historically notorious for creating onset knee pain. This may start with a slight niggle and grow into something much more degenerative including the likes of patella tendinopathies, chondromalacia, runner's knee or muscle tears. Incrementally adding weekly km’s to an athlete's total run load is the key to running longevity. The RSS run load rule of thumb encapsulates that adding 5-10% of total volume to the week is an acceptable increase for as long as every 3-4 weeks the athlete de-loads their run volume. For every new block of training, the athlete should increase their run load 5-10% extra from the previous week one of the previous block. Note, this is not from week four of the previous block. This restart of running load creates the perfect monthly increase in km’s so athletes can maintain their distance and slowly add km’s over periods of years, not weeks.
Conclusion
Ultimately, runners knee is a pain! It can be caused from many factors but none more damaging than strength imbalances, poor load management and tight, overactive muscles causing a pulling sensation on the knee joint. Strength through the Quadriceps, Glutes and Tibialis Anterior and flexibility through the ankle joint, Calves, Hamstrings and Glute Max muscles are a great combination to begin a strength routine for an athlete suffering with runner's knee. The team at Resistance Sports Science in Enoggera are a specialised team of Allied Health Professionals who work with many short to long-distance runners who have experienced the pains of runner's knee. It doesn’t have to be long-term if you follow the steps above and receive professional guidance! If you are a runner suffering from runner's knee, get in touch and lets see how we can help. Book a complimentary phone call with an RSS staff member and let's discuss your options!
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