Finally, winter is on the way out and thoughts are turning to the start of long-distance running season. With the London and Boston marathons taking place this month, it is also likely to be a brand-new season of Runner’s Knee.
Patellofemoral pain syndrome, to give it its proper name, is the most common injury amongst the running community – accounting for 16.5% of all running injuries. Essentially, it’s a dull pain that manifests itself behind or around the top of the kneecap and it can flare up whenever the sufferer squats, runs (particularly downhill), walks downstairs and even while sitting. The cause of the problem is the kneecap rubbing against the groove in the femur whenever you flex and extend the knee.
Not surprisingly, developing patellofemoral pain syndrome (PFPS) is one of the most effective ways of throwing a spanner into the works of your season’s training schedule, and has shortened – or ended – many a running career. If you’re female, you’re more likely to experience this particular complaint than men. It’s also possible to confuse it with patellar tendonitis, which is an entirely different complaint with its own specific treatment.
What causes Runner’s Knee?
The general assumption would be to automatically point towards the repeated pressure runners put on the knee, but the development of PFPS is often an indication of a problem occurring either above or below the knee joint.
Above the knee, core strength, ITB tightness and, in particular, glute strength, are all factors in the possible development of PFPS. In a systematic review, published in 2013 in the British Journal of Sports Medicine, growing evidence was found to support the link between gluteal muscle strength and patellofemoral pain syndrome and identified the need for further research into the effectiveness of gluteal strengthening in those affected.
Recent scientific research shows that people with poor quads and calf flexibility are also more likely to develop PFPS. The ailment can also be developed by people with a recent improvement in quad strength.
Often it’s the newly-converted members of the running community that are more likely to develop Runner’s Knee than their more experienced counterparts, who push themselves beyond their abilities or may be wearing poor or incorrectly fitted running shoes.
How to treat Runner’s Knee
In the short term, a period of RICE (rest, icing, compression and elevation) is recommended, along with a period of stretching involving lying on your side with your bad knee on top, bending the leg and them holding your ankle towards your behind, and holding it there for a period of 45 seconds with your knees together – an exercise you should perform for at least six times a day.
It goes without saying that while you’re experiencing pain in the knee area while you go about your day-to-day business, you shouldn’t think about running, but you should be looking at an exercise programme which can stretch and strengthen your quads and lower legs without adding to the problem.
Orthopaedic knee specialist Mr Jonathan Webb often recommends taking up pilates or yoga to improve strength above and below the knee joint. Many runners approach yoga with a great deal of skepticism, but its benefits for the dedicated runner are myriad, whether they are injured or not. Muscles and ligaments are gently stretched, circulation in the tissues is boosted and hip alignment is improved. In fact, strengthening the hips as opposed to focusing on the knees, can be very beneficial for those suffering from PFPS, according to a study published in the Journal of Athletic Training in 2015.
Researchers studied 199 people who’d been suffering symptoms of patellafemoral pain for at least four weeks, stemming from overuse rather than trauma. The subjects were divided into two groups, half that did knee and thigh exercises and half that focused on building up core and hip strength. Although the outcomes were similar, the hip group saw an earlier resolution in pain and greater strength gains, compared to those that followed purely knee rehab exercises.
When can I return to running?
PFPS is notorious for sticking around for weeks or even months, so don’t expect it to instantly go away just because you’ve started doing the right thing. The best-case scenario involves you detecting and isolating the problem as early as possible, taking a few days off to allow it to heal, and cautiously easing back into running – stopping the moment you feel the pain isn’t going away anytime soon.
Rarely does PFPS require surgery, but if symptoms persist you may require referral to an orthopaedic knee surgeon such as Mr Jonathan Webb. He will also be able to rule out other potential causes of the knee pain that may require surgical intervention.