Runners knee can affect anyone, from beginner runners who are just starting out to elite athletes trying to achieve their next personal best.
If you’re looking for practical solutions for relieving and avoiding this common overuse running injury, then you’re in the right place.
Today I’m going to share with you a simple step-by-step runners knee injury treatment and prevention program that can help put a stop to the condition for good.
By the end of this post you will know all you need about:
- The exact definition of runners knee and its symptoms, and causes,
- The best treatment options for runner’s knee,
- How to get back safely to running after runners knee, and
- The right preventative measures you can take so you no longer have to endure another (or your first) runner’s knee nightmare.
So are you excited? Then let’s get the ball rolling
Runner’s Knee Explained
Standing for a number of conditions affecting the knee, such as Patellar Tendinitis, Chondromalacia Patella, and Patellofemoral Pain Syndrome, or PFPS for short, Runner’s knee is a general term that’s been used to describe pain and tenderness around and/or below the kneecap.
PFPS is the most Common
Patellofemoral pain syndrome (what a mouthful!), is the most common form of runner’s knee, accounting for about 20 percent of all running injuries, according to study.
Note: This whole post is mainly focused on patellofemoral pain syndrome.
In future posts, I’ll be dealing other conditions affecting the knee.
That’s why in this post, I’ll be using the terms PFPS and runner’s knee interchangeably, but please keep in mind that they are not the same thing.
Runners Knee Symptoms
The primary symptom is mild pain around, and below the top of the kneecap, typically toward the center of the back of the knee where the kneecap and thighbone meet.
The pain is, in most cases, mild at the first stages and may be only felt during running (or while doing other high impact exercises), but the pain becomes increasingly more intense not only during running but also after a workout.
Since the knee is a joint—Read: it moves around a lot—pinpointing the exact painful spot can prove difficult.
Nevertheless, by and large, Runner’s Knee is described as an aching pain behind and/or around the kneecap.
To make sure you actually have PFPS, you may need to visit a doctor to give you a thorough physical exam.
In some cases, X-rays and MRIs—Magnetic Resonance Imaging)—and other tests are needed for a complete assessment.
But in most cases, if you are a runner, and you started experiencing the above symptoms, rest assured that you have runner’s knee, and it’s time to step back from running and treat the condition before you do more damage to the cartilage.
You may also experience swelling and/or popping or cracking sensations in the knee.
Additional Resource – Can you run again after knee replacement
Runners Knee – The Injury Process
At the root level, runners knee develops when the patella (the kneecap) tracks incorrectly over the femoral groove, which a groove in the thighbone—as you use your knee.
Under normal conditions, the patella rests in the femoral groove and glides effortlessly up and down as you bend and straighten your knee.
But when the patella is misaligned—or tracking out of its normal range— it can irritate the nerves around the kneecap and damage the cartilage beneath the patella, leading to knee pain and eventually, runners knee.
Not Just Runners
As I have already stated, Runners’ Knee is the most common overuse injury among runners, but it can also strike any athlete in a variety of fields—especially sports that require plenty of cutting and sharp lateral movements, such as skiing, basketball, and tennis, or any type of sport that’s arduous activity on the legs.
Runners Knee Causes
Pinpointing a single cause of runner’s knee may prove elusive.
There are so many factors that can lead to the condition.
Here are some of the causes:
Overuse. This is the most common cause.
The repetitive high impact nature of running—and other high impact activities that are strenuous on the knees—can irritate the nerves around kneecap and damage the tendons.
Misalignment. When the patella—kneecap—is slightly out of its correct position—in other words it’s out of alignment—running and other high impact activities that require a lot knee bending and twisting can wear down the cartilage of the kneecap, leading to pain and damage to the joints.
Muscle weakness. Muscle imbalances in the legs can also lead to the condition.
Weak glutes, hip abductors, and quadriceps muscles can reduce support and stability around the knees, which forces the kneecap to track out of alignment.
Muscle tightness. Tight hamstrings and calf muscles can put pressure on the knee, resulting in misalignment of the kneecap, thus increasing kneecap friction and pain.
Add to this the repetitive high impact nature of running and you have a recipe for runners knee.
Foot problems. If you have flat feet—also known as fallen arches or overpronation—this anatomical condition can overstretch the muscles and tendons of your legs, resulting in knee pain and irritation.
An unusual foot position forces the foot to roll inwards which significantly changes the way the forces go through the knee
Direct trauma. This is when you receive a direct trauma to the knee, such like a blow or a fall.
The shock impact can dislocate the kneecap, or even move it out of place, forcing it to mal-track over the femoral groove.
How to Treat Runner’s Knee
If you have runners knee, then there is no perfect answer to when your knee will be healed.
Nevertheless, to speed up the healing process, do the following.
This is obvious.
Stop doing anything, including running and other high impact exercises, that leads to knee pain, but feel free to do as much exercise as you can do pain-free.
Take as many recovery days (or weeks) as you need.
If you don’t want to stop exercising, then opt for cross training activities with minimum impact on the knee.
Join a yoga class, strength train or join a aqua jogging class.
Just because you have runners knee don’t mean that you should fall off the training wagon, and turn into a couch potato.
Ice your Knee
Ice therapy can help you assuage pain and reduce the swelling.
Do it for 10 to 15 minutes three to four times per day until the pain is gone.
Use cold packs or ice wrapped in a towel.
Compress The Knee
Support the injured knee by using sleeves, straps or an elastic bandage to accelerate the healing process and reduce pain.
Elevate your Knee
Another measure you can take is to keep the knee raised up higher then you chest level by elevating it on a pillow when you are sitting or lying down.
Take Anti-inflammatory Pills
I will only recommend that you take pills if the pain was too much to bear.
Non-steroidal anti-inflammatory medication, like Aleve, Advil, or most commonly Ibuprofen, will help with the swelling and the pain—especially if you needed more pain relief.
Just be careful. These drugs—like any other drug—have a dark side.
They can boost the risk of bleeding and ulcers—only used when your doctor says so or in cases of severe pain.
See a Doctor
In case your knee did not get well with the above steps, and the pain persists, then you may need to see a physician and have a professional examine your knee for a thorough medical evaluation.
In most cases, runners knee can be easily treated provided that you spot it early on and take the necessary action steps on the spot.
Severe Runners Knee Cases
In some severe cases of runner’s knee, the above steps may not help as much.
So what to do then?
Well, severe cases of the runner may need immediate surgery to fix the damage.
A surgeon could take out the injured cartilage or mend the position of the patella.
Hopefully, you will never have to endure severe cases of runner’s knee.
This condition—and most other running injuries—can be easily treated—when spotted at the right time and before they get any worse—and with the implementation of the right preventative strategies.
Additional resource – Your guide to ITBS
How to Get Back Running after Runner’s Knee
Here are the three keys to return safely to running after runner’s knee
Take your Time
Returning back to running, of course, will depend on how severe you damaged your knee.
Thus, it’s hard to guess how much recovery time you will need, especially when you put into consideration the biomechanical causes of the condition.
You cannot fix your muscles imbalances or running mechanics overnight.
So this cannot be rushed up. No one can
For instance, you may only need a few days off if you spot runners’ knee early, but if you have been running through pain for a while, you may need a lot longer.
But as a general guideline, full recovery from runner’s knee can take from four to eight weeks (or even more in severe cases) of no irritating activities—including running and other activities that require a lot of knee bending and twisting.
To stay on the safe side, opt for cross-training activities that don’t aggravate the pain and require minimum knee twisting and effort.
Take up aqua jogging, swimming, and the like.
And if a cross-training activity leads to knee pain, you shouldn’t be doing it.
The same approach applies for other knee injuries such as ITBS and patellar tendonitis.
Depending on how long you were out of the running field, it will take you to get back to running the way you used to.
A loss of cardio base and stamina is expected after a moderate layoff—even for just a couple of weeks.
Restart your running engine carefully and slowly.
Don’t force it.
Adopt a beginner’s runner mindset.
Fix the Root-Cause
Whether the root cause of your injury was biomechanical or any other cause, you will need to continue on working on it until it poses no future threats.
So please keep in mind that if you don’t strive to gradually fix the root-cause, it won’t just repair itself.
That was my mistake.
And please don’t repeat my mistake.
Additional Resource – Overpronation vs Underpronation
How to Prevent Runners Knee
The best way to not suffer from runners knee to build the right foundation that will bulletproof your body against runners knee, as well as other running injuries.
After all, an ounce of prevention is worth a pound of cure, as the saying goes.
Here is what you need to do.
As I stated earlier, muscle weakness—especially the muscles surrounding and supporting the knees—is a critical factor in the development of the condition.
Focus on the Glutes & Hamstrings
Glutes are the powerhouse of your lower body.
When you run, these muscles support your pelvis and keep it steady, and also keep your legs, pelvis and torso aligned.
But when your glutes are too weak for the job, your entire kinetic chain suffers, affecting knee alignment like nothing else.
Plus, strengthening your quadriceps might improve patellar tracking, adding more support to your knees.
Consequently, your off-road strength routine should include plenty of exercises to strengthen these muscle groups.
Do the following 5 exercises, either as a part of your regular strength routine, or as a whole routine in itself if you have a history of the condition, or still suffering, from knee pain.
These exercises will definitely help you improve strength and balance in the region.
Additional resource – Knee support for runners knee
Side leg lifts
Stretch Your Muscles
After the strength comes the flexibility and mobility work.
By keeping your muscles loose and flexible, the kneecap will be able to glide easily up and down the patellar groove without much friction.
So do your best to stretch your lower body muscles—especially your calves and hamstrings.
Foam roll, too.
These two options are a great complement to strength training and loosen up tight quadriceps, hamstrings, and calves.
Try to incorporate these three stretches into your training program.
Additional resource – How to start aqua jogging
Strap Calf Stretch
Hip Flexor Stretch
Run on Proper Surfaces
Running is a high impact activity, and doing it on hard surfaces, like asphalt and concrete will only add more undue stress on your knees.
Do the bulk of your running on softer surfaces, such as grass, trails, or a synthetic track with a more soft surface.
Or, at least, vary your running routes.
Improve Your Running Form
Following sound running form and other mechanics is also another powerful key that can help you ward off runners pain for good.
Try incorporating these four bullets into your daily running routine.:
Run tall with a slight forward lean
Keep your body relaxed the entire time
Aim to land on the fore-foot instead of the heel.
Improve your running cadence, shooting for 170 to 180 steps per minute.
Additional resource – Running shoes for overpronators
Proper Running surfaces
Improper running surfaces, like concrete and asphalt, can put excessive stress on the knees, increasing the risks of the condition.
Do your knees a solid and do the bulk of your running on grass, woodland trails or a synthetic track with a merciful surface.
Change u your running routes because doing so helps you vary your foot strike and stride, thus keeping your muscles balanced and reducing repetitive stress impact—keys for warding off injury.
For instance, if you are a professed trail runner, try an indoor track, and vice versa.
If you are more prone to runner’s knee—whether you are biomechanically challenged or have a bad history of runner’s knee—you can use special insoles that can be worn on your shoes to support your foot position, thus reducing the amount of stress going through the kneecap.
Plus, orthotics can also help you recover faster from the condition and assist in runner’s knee rehab.
Watch your Body Weight
Knee pain is most common among overweight beginner runners for an obvious reason: The heavier you weigh, the more load you put on your knees.
And by losing weight and getting in shape, you avoid overstressing your knees, decreasing the risks of pain and injury.
Therefore, if you are overweight and looking to shed the extra pounds with running, you should go after your weight loss goal without hurting yourself.
In other words, you should aim to get fit without getting hurt.
Check my article on how to start running the safe way.
Steady and Slow
This is a no brainer.
Most running injuries, not just runners knee, are usually the result of the runner trying to do too much too soon.
So be cautious, especially if you have just started out running.
As a result, be sure to increase training intensity gradually and work it up to the distance you want to run over long months of training.
Nothing happens overnight.
And any sudden changes your training intensity leads to all sort of problems.
Listen to Your Body
In my personal experience as a runner and fitness expert, the best thing to do to help you prevent running injuries—not just runners knee—is to simply listen to your body and adjust your training accordingly.
If you learn one thing from this whole article, then this is what you need to keep in mind all the time.
Keep a keen eye (and ear) on your body throughout your workouts and afterward.
If your body hurts, then you need to stop whatever you are doing and back off until the pain subsides.
Your body needs time to adapt to a new training stimulus.
If you tried to skip that phase, then you are heading in the wrong direction, buddy.
So at the first sign of pain, back off, and rest until the pain subsides.
If you persist on running with pain, then you are setting yourself up for a major setback.
Here is my master 3-step plan for preventing runner’s knee (and runner’s pain) for good.
- Strengthen your lower body muscles
- Improve flexibility
- Improve running form and mechanics
Let’s start discussing each measure and learn why they are paramount to warding off runners’ knee in the future.
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