Outrunning Knee Pain


Outrunning Knee Pain

Patellofemoral knee pain (Runners Knee)

Runners are a rare breed, people driven by a sport of solitude, endurance, and sacrifice; an activity where mental and physical taxation on the body is high and often times with consequence.  We often ignore signs of pain and fatigue and push through to complete one last lap, PR on a local 5k or simply to feel the rush of chemicals and endorphins that overtake the body on known as the “runners high.”  We run in the mornings, afternoons, evenings, eat the right combination of protein and carbs, rotate shoes on a daily basis, and let’s not forget HYDRATE, HYDRATE, HYDRATE!!!  But one thing we are not very good at doing is listening to our body, acknowledging signs and symptoms that may lead to chronic injuries.

One of the major injuries that sideline runners is Patellofemoral Pain Syndrome (PFPS), more commonly known as “Runners Knee.” This is the most common overuse injury among runners accounting for 40-45% of running related injuries. It occurs when the patella (kneecap) falls out of alignment with the femoral groove and irritates the surrounding area as well as the undersurface of the patella.  The femoral groove is located at the end of the femur (thigh bone) and provides the patella a track on which to move during movements such as knee flexion and knee extension.  Causes of this phenomenon may be biomechanical in nature, where the patella sits too high on the groove and is easily displaced or dislocated during tracking.  High arches, flat feet, excessive pronation or supination can start a chain of events ultimately leading to the patellar maltracking. Muscular imbalances may also contribute to PFPS. Tight hamstrings and calf muscles will not allow full and fluid extension of the knee keeping the patella deep in the groove and in constant contact with the femoral groove, leading to an irritation of the undersurface of the patella and surrounding tissue.  Overall weakness in the quadriceps muscles coupled with improper action sequencing of the quads, may lead to the patella being pulled out of alignment further increasing the possibility of patellar maltracking.

Symptoms include tenderness behind or around the patella, swelling around the knee, the feeling of your quadriceps giving out. Pain may be experienced in the back of the knee, and there may be a feeling of cracking in the knee especially with movements. Running on uneven terrain, along with ascending and descending steps and hills can aggravate PFPS.

To prevent PFPS, run on softer more even surfaces. Many high school tracks offer the public a chance to use their facilities.   High school tracks are very cushioned and flat and will help with shock absorption and lessen instability in the ankles promoting a more smooth and fluid run.   Keep mileage increases less than 10 percent per week, rapid increases in mileage may lead to excessive muscle fatigue, promote poor running form which in many cases will lead to an overuse injury.   Get into the gym and cross train, strengthening your quadriceps as well as hamstrings and core muscles will help improve patellar tracking.  Visit a specialty running shop to make sure you’re wearing the proper shoes for your foot type and gait.  Proper shoes will lessen the movement in the arches and ankles provide more stable support and allow for proper distribution of pressure along ankle and knee joints.

At first signs of pain and or discomfort in your knee, lessen the workload on your knee.  Reduce your mileage and rest your legs, and re evaluate your stride and consider proper shoe wear.  With proper preventative care pain will be minimal however you should not try to diagnose yourself based on pain presentation and the “internet doctor.”  See your local specialist if pain persists or becomes too intense that it limits your everyday activity.

Michael Bedolla, M.Ed, MSPT, PT