Out of all the injuries I see, this is the most common among runners and non-runners alike. For some it is a short-term problem and others it is a life-long struggle. Runner’s Knee is usually associated with an increase in activity. This can be increased mileage, increased hills, or just over-doing it on one particular day. Pain is often worse after exercise. The pain can be felt on any side of the knee, but most often on the front. Pain is worse after getting up from rest, with sitting for a while with your knees bent (the Theatre Sign), or with going down stairs.
So what causes it? The answer is really in the name- Patellofemoral (meaning knee cap and thigh bone) Syndrome. It is essentially a problem with alignment. A good comparison is that of a rope in a pulley. If the rope stays in the center of the pulley then everything runs smoothly, but if the rope is pulled off to the side then there can be uneven wear and fraying of the rope. The knee is just the same. There is a groove in the bottom of the thigh bone that acts like a pulley. The knee cap, its tendons, and the quadriceps muscle act as the rope. So, if the alignment of the knee is off, then there is uneven wear under the knee cap, causing inflammation and pain.
There are a variety of things that can contribute to runner’s knee. Some of these issues cannot be changed like the bone anatomy, the tightness of ligaments, and how ‘knock-kneed’ you are. Others can be influenced like muscle strength, foot arch, and pelvic alignment.
The mainstay of initial treatment is relative rest, strengthening of the thigh and hip muscles, and anti-inflammatory medications. Other treatments of benefit are bracing, taping, and pelvic adjustment. Rarely, is surgery a considered option. So, if this sounds like something that you may be dealing with I would suggest taking a step back on your training and search the web for ‘Patellofemoral exercises’. It will take 2-4 weeks to see improvement with these exercises. If these are not helpful, pay your friendly neighborhood sports medicine doctor a visit.
Matt Evans, MD
Dr. Matt Evans is a sports medicine doctor practicing with Utah Valley Orthopedics & Sports Medicine. He lends his expertise at RACETRI events by patching up road rash, helping athletes overcome hypothermia, dehydration and with his team runs overall triage at the race. More than a medical expert Dr. Evans is an athlete who has completed triathlons. Do you have an injury or sports medicine question? Find Dr. Evans near the finish line for an exam & expert advice.