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What is runner’s knee?

Patellofemoral Pain Syndrome (PFPS) or runner’s knee is a general term for a number of conditions that cause pain in the patellofemoral joint and the surrounding tissues. This joint is the intersection between the kneecap (patella) and the thighbone (femur). Those with runner’s knee may feel a burning sensation or a dull ache under and around the kneecap. Some people also experience swelling as well as a cracking, popping or grinding sensation.

Runner’s knee is usually created by muscle weakness or tightness around the leg, causing the patella to bump against the femoral groove (end of the femur). Occasionally, the pain may be due to torn cartilage or strained tendons. As the name suggests, runner’s knee is prevalent in runners but it is also caused by other high impact or high load activities such as skiing, jumping or squats. The good news is there’s lots we can do to help prevent it….

How do I avoid getting runner’s knee?

1. Increase your training gradually

Avoid dramatically increasing your training volume and intensity. The mileage and duration of your runs should be built up incrementally. The general rule of thumb is that you should never increase your training volume by more than 10% each week. This allows the body time to recover and adapt[1].

 

For example,

  • Week 1: 20 minute run

  • Increase volume by 10%

  • Week 2: 22 minute run

2. Make time for stretching and mobility work

Stretching regularly and performing mobility movements can help to optimise function at the knee joint. Ideally these should be specific to your needs and the demands of your sport and lifestyle, however below are a few stretches specific to reducing the risk of knee injury.

 

Lying Glute Stretch:

  • Lie on the floor face up, with knees and hips bent.

  • Place your left ankle across your right thigh.

  • Grasp your right thigh with both hands and pull it towards your chest gently.

  • Hold for 20-30 seconds, before repeating on the opposite leg

Kneeling Hip Flexor Stretch:

  • Start off in a kneeling lunge positon, with one leg on the floor and the other bent 90 degrees in front of you.

  • Shift your body weight slightly forward while maintaining an upright positon.

  • Hold for 20-30 seconds and then slowly release. Then switch sides.

Heel Drop/ Calf Stretch:

  • Stand on the edge of a step or a block. Place the left foot on the ground, keeping the ball of the right foot on the step.

  • Slowly lower the right heel, so it drops below the step.

  • Hold for 20-30 seconds, before slowly lifting it back up.

  • Repeat several times before changing sides. 

3. Use strengthening exercises

A full body strength program should be followed by everyone looking to optimise performance and health whilst reducing the risk of injury. Below are a few exercises which target the leg and core muscles and can be performed anywhere:

The Clamshell:

  • Lie on one side propped up on your forearm, with your knees bent on top of each other and your hip on the floor.

  • Keeping your feet together, lift your top knee towards the ceiling (opening the clamshell). Make sure your core remains stable.

  • Lower leg back down and repeat.

  • Aim to do 3 x 10 of these per leg.

Single Leg Squat:

  • Stand with both feet pointing forward, hip width apart.

  • Raise the left leg off the floor and balance on your right foot.

  • Bend the right leg and slowly lower yourself down into a squat position. Make sure you keep your right knee centred over the ball of your foot.

  • Push back up slowly.

  • Try and aim for 3 sets of 6 repetitions per leg.

Side plank leg lift:

  • Start on your side supporting yourself on your elbow, with the lower leg bent at the knee behind you.

  • Make sure hips are level and raised from the ground

  • With a straight top leg, raise it off the floor to a comfortable height without moving the rest of your body.

  • Then slowly drop the leg back down.

  • Try and aim for 3 sets of 6 repetitions per leg

4. Invest in good running shoes

Running shoes help absorb the shock every time your foot hits the ground. The duration that shoes last varies; however, they usually last between 300 to 450 miles[2][3]. After this they lose their cushioning and become less supportive, which could lead to injury.

It is also important that you wear running trainers that support your foot shape as well as your gait. Many sports shops offer a gait analysis test. This looks at the way the foot rolls (pronation and supination) while walking or running, to determine which shoe is best for you.

5. Refine your running style

Your running style can influence the load placed on your knees whilst running. A professional running coach is your best bet for individual guidance, however below are some generally accepted principles to support good form:

  • keep your knees soft and bent during the landing phase of your stride. A full extended leg can have a high impact on the knee joint.

  • Feet should be pointed in the direction of travel; if the foot is facing the side it can have a twisting effect on the knee and the ankle.

  • Avoid heel striking, which is when the heel contacts the ground first during a stride. Instead, try to land with your whole foot and under the knee. This reduces the impact load on the knee joint.

  • Review your cadence (strides per minute). If your cadence rate is too low, it can cause you to over-stride and heel-strike. Increase your cadence rate by taking shorter strides so that you can maintain the techniques above. 

6. Take a break from the concrete

Running on hard surfaces requires the joints to absorb a lot of repeated impact. It can be helpful to utilise other terrains when possible. Rather than running on a pavement, try running in a field or off-road. If this isn’t possible treadmills or running tracks can offer a suitable alternative.

Where can I get further guidance?

If you’re suffering from knee pain or looking for ways to prevent knee pain, the team at Optimi are here to help. Access our sports medicine physios and our injury prevention plans via our app 

For reference and further reading:

Nielsen RO, Buist I, Sørensen H, Lind M, Rasmussen S. Training errors and running related injuries: a systematic review. Int J Sports Phys Ther – https://pubmed.ncbi.nlm.nih.gov/22389869/

Rethnam, U., Makwana, N. Are old running shoes detrimental to your feet? A pedobarographic study. BMC Res Notes 4, 307 (2011) – https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-4-307

Wegener C, Burns J, Penkala S: Effect of neutral-cushioned running shoes on plantar pressure loading and comfort in athletes with cavus feet: a crossover randomized controlled trial. Am J Sports Med. 2008 – https://pubmed.ncbi.nlm.nih.gov/18577583/