Runner's Knee 101: Causes & Treatment

By Meghan Clark ATC, LAT


When the gyms closed down, people immediately took to running. Even those who wouldn’t normally consider themselves to be runners are starting to develop a running routine to stay active. Keep reading to learn more about if the pain you're feeling in your knee could be the result of Runner's Knee.


What is Runner’s Knee?

The main symptom of Patellofemoral pain syndrome (PFPS) is a pain in the front of the knee with a flexed-knee position while weight-bearing, and many also experience stiffness or pain after sitting for long periods. An evaluation should be completed to determine any pronation or rearfoot eversion, posture concerns, and muscular imbalances that may be causing symptoms.


Hip and ankle strength and function are pivotal aspects of proper mechanics. Ensuring mobility and stability in these joints will allow for better function at the knee joint.

Who is likely to get Runner’s Knee?

Also known as Runner’s Knee, PFPS can cause anterior knee pain in young athletes, most of which are female (4). 70% of cases occur when athletes are between the ages of 16-25 (4).

There are many factors that can contribute to the development of PFPS, including anatomical changes, increase or change in activity, gait patterns, posture, and footwear.

How does this happen?

Let’s begin with basic anatomy. The patellofemoral joint is made up of the patella and femur. When bending the knee such as with running or squatting, the patella glides in a groove on the femur. This movement should be pain-free.


The Q-angle provides insight into the angle of forces on the knee. The greater the Q-angle, the greater the forces on the knee. Because females have wider hips, the Q-angle is greater, which predisposes them to PFPS.

The vastus medialis oblique, or VMO, plays a key role in proper patellar tracking. Weakness in the VMO, imbalance of the quadriceps muscle, or IT band tightness can pull the patella out of the normal movement pattern, causing PFPS. If there is weakness in the hip stabilizers, the femur may internally rotate, the tibia may externally rotate, and the inside of the foot may take the excessive load.

Another potential issue is limited dorsiflexion, which is the movement of bringing your toes up towards your shin. If this is limited, it can cause toes to point outward which can place excessive stress on the patellofemoral joint while performing activities. All of these factors will change the torque on the patellofemoral joint and could be the cause of your pain.

What do I do if I am already experiencing this pain?


1. Reduce your activity. Getting the pain under control is the first step. Limit or reduce activities that cause pain. Take NSAIDS to help reduce the inflammation, and ice 1-2 times daily. Stretch and foam roll all muscles affecting the knee, including quadriceps, hamstrings, IT bands, and gastrocnemius.

2. Address any imbalances through rehabilitation exercises. Seek an evaluation from your athletic trainer or physical therapist; they will be able to determine the cause of your pain and address the specific muscle groups or tracking abnormalities to correct the issue. Some taping techniques and bracing may also help reduce symptoms while progressing through strengthening. They may suggest orthotic inserts as well, which would support your foot during activity to maintain correct alignment.

3. Reintegrate normal exercise levels. Once any strength discrepancies have been addressed and pain is under control, the last step is to get back to all activities you like to enjoy!

References

1. Gaitonde DY, Ericksen A, Robbins RC. Patellofemoral Pain Syndrome. American Family Physician. https://www.aafp.org/afp/2019/0115/p88.html. Published January 15, 2019. Accessed April 30, 2020.

2. Hillyard H. WHAT IS A Q ANGLE? Champion Performance & Physical Therapy. http://www.kcchampionperformance.com/news/2016/3/9/kx8hq9n3wmbt2pbqy683hisu4y1xm4. Published March 9, 2016. Accessed April 30, 2020.

3. Summit Medical Group Web Site. Summit Medical Group. https://www.summitmedicalgroup.com/library/adult_health/sma_patellofemoral_pain_syndrome/. Published 2014. Accessed April 30, 2020.

4. Vora M, Curry E, Chipman A, Matzkin E, Li X. Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options. Orthopedic reviews. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850065/. Published February 20, 2018. Accessed April 30, 2020.

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