Runner’s Knee

As the name suggests, runner's knee or patellofemoral pain syndrome is a common ailment among runners. But it can also strike any athlete who does activities that require a lot of knee bending -- like walking, biking, and jumping. It usually causes aching pain around the kneecap. Runner's knee isn't really a condition itself. It's a loose term for several specific disorders with different causes. Runner's knee can result from:

  • Overuse. Repeated bending of the knee can irritate the nerves of the kneecap. Overstretched tendons (tendons are the tissues that connect muscles to bones) may also cause the pain of runner's knee.
  • Direct trauma to the knee, like a fall or blow.
  • Misalignment. If any of the bones are slightly out of their correct position -- or misaligned -- physical stress won't be evenly distributed through your body. Certain parts of your body may bear too much weight.   This can cause pain and damage to the joints. Sometimes, the kneecap itself is slightly out of position.
  • Problems with the feet. Runner's knee can result from flat feet, also called fallen arches or overpronation. This is a condition in which the impact of a step causes the arches of your foot to collapse, stretching the muscles and tendons.
  • Weak thigh muscles.   Quadriceps may overpower Hamstrings or visa versa.  Iliotibial Band shortening may also pull knee cap laterally and cause pain

Runner's knee

What does Runner's knee feel like?

Symptoms of runner's knee are:

  • Pain behind or around the kneecap, especially where the thighbone and the kneecap meet.
  • Pain when you bend the knee -- when walking, squatting, kneeling, running, or even sitting.
  • Pain that's worse when walking downstairs or downhill.
  • Swelling.
  • Popping or grinding sensations in the knee.

What's the Treatment for Runner's Knee?

Regardless of the cause, the good news is that minor to moderate cases of runner's knee should heal on their own given time. To speed the healing you can:

  • Rest the knee. As much as possible, try to avoid putting weight on your knee.
  • Ice your knee to reduce pain and swelling. Do it for 20-30 minutes every 3-4 hours for 2-3 days, or until the pain is gone.
  • Compress your knee. Use an elastic bandage, straps, or sleeves to give your knee extra support.
  • Elevate your knee on a pillow when you're sitting or lying down.
  • Take anti-inflammatory painkillers. Nonsteroidal anti-inflammatory drugs, like Advil, Aleve, or Motrin, will help with pain and swelling.
  • Practice stretching and strengthening exercises
  • Get arch supports for your shoes. These orthotics -- which can be custom-made or bought off the shelf -- may help with flat feet.

Can Massage Help?                                                                    

2007-01-16 16.21.10

The old children’s song is true; the entire body is connected and any treatment must recognize this. Just massaging the knee and leg isn’t going to solve this problem. Faulty hip mechanics are recognized as being linked to this condition although it is unclear if this is a cause or an effect of runners knee.

There is growing evidence to support the association of gluteal muscle weakness in individuals with runners knee and the effectiveness of gluteal strengthening when treating the condition. The gluteus medius is one of the main stabilizers of the hip. When it’s under-active the opposite quadratus lumborum (QL) becomes overactive, often causing low back pain and stiffness.

If the gluteus medius is weak, the tensor fascia lata (TFL) will also substitute, causing it to become short, tight and painful to touch. The other areas that may need working on include the iliotibial band, the iliopsoas and possibly the piriformis.

Target muscles for therapeutic treatment are Glutes, hip rotators, TFL, ITB and last but not least the balance between Quads and Hamstrings.


How Can I Prevent Runner's Knee?

There's a lot you can do to prevent runner's knee. You should:

  • Keep your thigh muscles strong and limber with regular stretching.
  • Use orthotics -- inserts for your shoes -- if you have flat feet or other foot problems that may lead to runner's knee.
  • Make sure your shoes have enough support.
  • Avoid running on hard surfaces, like concrete.
  • Stay in shape and keep a healthy weight.
  • Never abruptly increase the intensity of your workout. Make changes slowly.
  • Wear a knee brace while exercising, if you have had runner's knee before.
  • Buy quality running shoes and discard them once they lose their shape or the sole becomes worn or irregular.

By Karen Giglio, LMT


American Academy of Orthopaedic Surgeons: "Runner's Knee."

Arroll, B. British Journal of General Practice, February 1999.

Fulkerson, J. American Journal of Sports Medicine, May-June 2002.

Rouzier, P. The Sports Medicine Patient Advisor, second edition, SportsMed Press, 2004

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.