What is Runner’s Knee and how is it Treated?

Orthopaedic & Spine Center
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by Boyd W. Haynes III, MD

As a Sport Medicine Specialist, I see lots of runners who complain of knee pain.  Although there are many reasons for knee pain, including a torn meniscus, arthritis, a torn ACL, etc., most of the runners I see suffer from Patellofemoral Syndrome – aka, Runner’s Knee.  In this article I will discuss diagnosis and treatment for this very commonly reported condition.

First, a little anatomy lesson.  The patella is the kneecap and the femur is the thighbone.  They are joined in the knee joint where the patella glides in a groove along the bottom of the femur during walking or running.  Causes of runner’s knee can be mechanical, e.g., the kneecap is prone to dislocation or sits more to one side than the other, the cartilage in the knee is worn more on one side than the other, or the runner is flat-footed or has high arches, causing pronation.  Muscular issues include tight hamstrings and/or thigh muscles that are not well-conditioned and strong, resulting in the kneecap being forced to bear a disproportional load, which can cause abnormal tracking and alignment.   It can also be caused by repetitive motions or injury.  Add one or more of these together and viola, you have Runner’s Knee.

Despite the name, it can also happen in folks who walk, bike or jump a lot during their workouts.  It occurs twice as often in women than in men, due to the fact that a woman’s hips are wider for childbearing, they have less muscle mass than men and the angle from their hip to the knee is greater, causing more stress on the knee.

How do you know you have Runner’s knee?  When you come to see me for a diagnosis, I am going to ask you lots of questions, especially about the location of your pain and when it happens.  I usually hear about pain around the kneecap, although it can also hurt in the back of the knee and a feeling that your kneecap is about to give out.  You may have swelling or grinding sensations in the knee. Knee pain will usually increase when running down hills, walking down stairs, or doing knee bending activities.

I will x-ray your knees to rule out arthritis or some other mechanical issue.  I am also going to get you to point specifically to the areas of the knee that hurt. True PFS has no discernable structural anomalies based on diagnostic testing like X-rays or MRI.  There is now a school of thought that believes PFS is just a chronic overstimulation of the nerves in the knee, causing pain.

What I recommend for Runner’s knee is an immediate decrease of running.  In severe cases, stop running.  This usually makes most runners want to scream; however, hear me out.  You need to get some rest so that the inflammation will die down.  That also goes for working out on slanted or hilly surfaces or doing a lot of deep knee bends.  Concurrently, I will recommend Physical Therapy to strengthen thigh muscles and to get those tight hamstrings to relax and stretch.  I may prescribe anti-inflammatory medications.   Ice is great for pain and swelling. A compression sleeve may also help. Go to a specialty running store for a gait analysis and make sure you have the best running shoes for your feet and gait.

When we see a resolution of symptoms, I will help you get back to running successfully.  We do that by going s-l-o-w-l-y and not increasing your distances by more than 10% a week.  Stride adjustments and taking more and smaller steps may help. If those fancy new running shoes aren’t exactly doing the trick, I may order Orthotics to help with high arches or flat feet.  I advise running on softer surfaces and avoiding concrete.

If you are a dedicated runner, the last thing you will want to hear me say is “quit running in order to heal”.  However, channel that frustration into your physical therapy and finding good running shoes.  You’ll be back running in no time.