Could It Be Runner’s Knee?

By Allister Horncastle

As we all keep to the government’s regulations – which thankfully are continuing to ease – in the clinic I am noticing an influx of people with non-specific knee pain. It’s often from an increase in running or from commencing a running program. However, it’s not just runners that are getting this pain: it’s also experienced by gym junkies, gardeners, walkers and non-fitness folks alike.

With this type of knee pain, you often don’t remember a specific event that injured your knee. Instead, you notice that your knee starts to hurt during, after or the day after physical activity.

What you’re experiencing is likely Patellofemoral Joint Pain (PFJP), commonly known as ‘Runner’s Knee.’

It’s likely you’ll have pain at the front of the knee towards the middle, but pain can also present on the outside, at the back or any combination of the above. It may warm up as you exercise, worsen so you have to stop or you may only notice it post activity.

A recent patient of mine started running after a long layoff and pulled up sore.

This continued for 2 weeks until she attended the clinic. Her pain was under the kneecap and towards the middle, and it would be sore while she running, with the pain continuing until the following morning. Interestingly, she had the same pain when she was sitting at her desk with her knee bent for prolonged periods at work, even when she had rested the day prior. This is another common characteristic of Runner’s Knee. It might sound familiar to some of you?

What’s occurring in this scenario is an abnormal biomechanical load through the patellofemoral joint (the joint between the kneecap and thigh bone). Unlike the majority of joints in the lower limb, the patellofemoral joint isn’t rigidly held in position by strong and taught ligaments, so it is more vulnerable to a number of internal and external factors. 

Internal factors include:

  • Tight and/or weak muscles around the hip and the rest of the leg
  • Stiff joints
  • Flat feet
  • Inflammation
  • Previous injury
  • Poorly aligned bony architecture

External factors include:

  • Inappropriate footwear
  • Altered training surfaces
  • Altered training loads
  • Ergonomics
  • Diet
  • Age

A physiotherapy program can be tailored to target an individual’s internal and external factors, and in the vast majority of cases, you will return to your chosen activity. In other more severe cases, external referral may be required and this can be provided by your physiotherapist. In either case, if your knee pain sounds anything like this, physiotherapy should be your first point of call.

For my patient, her knee pain was caused by a combination of both internal and external factors. We were able to:

  • Alter her running program to allow sufficient rest between runs
  • Get her in more appropriate shoes for her foot type
  • Loosen tight muscles
  • Reduce inflammation
  • Strengthen the muscles around the hip to allow normal biomechanics of the lower limb

This process took multiple sessions over only a few weeks and she is now running pain free and would have been able to run the HBF Run-For-A-Reason in May.

For more assistance, please contact your local Physio Pro.

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