Runner’s Knee, A Common Ailment Of Lockdown Running
In these times of confinement and lockdowns, many people are rediscovering the simple, freeing, joys of running. Die hard runners are still running as usual, but there seems to be a resurgence of lapsed runners, or people taking the “couch to 5k” challenges as a way to move in and out of these repeated lockdowns. When you think of it, there is nothing indeed more liberating than to pop a pair of running shoes and head out the door to empty your mind.
However, sometimes the body doesn’t always follow suit. The dreaded “runner’s knee'“ is unfortunately a very common injury and can affect tentative beginners to advanced runners.
Runner’s knee is also know as patellofemoral pain syndrome, peripatellar pain syndrome or simply, anterior knee pain. It is commonly described as a deep dull ache or sometimes sharp shooting pain located in the front of the knee, sometimes on the medial aspect of the kneecap. Pain is usually felt during running, after sometimes something as little as 5 minutes into the run. Pain is also often felt after prolonged periods of sitting with the knee bent, or when walking down (or even up) the stairs. Patients often complain that bending the knee (flexion) will aggravate the symptoms. This is because flexion compresses the local inflammation (inflammation hates being squished). Flexion also compresses the articular surface of the kneecap onto the thigh bone (femur), which in turn increases the forces into the injured area and leads to pain.
The knee joint is a complex joint (and a fascinating joint to me!). It involves the femur bone, the tibia bone, the knee cap, and many ligaments, fat pads (bursae), two menisci, muscle tendons, and structures that hold everything in place (retinaculum). The aforementioned soft tissues (apart from the menisci) are highly innervated, which means they are a key source of pain. The infrapatellar fat pad, a bursa located inferiorly (south of) the knee cap and under the patellar tendon (the insertion of the quadriceps into the tibia), is actually the most sensitive tissue in the knee as it is richly innervated by branches of the femoral, common peroneal and saphenous nerves.
With all these complex and pain-sensitive structures, It is no surprise that anterior knee pain can be so prevalent.
Risk Factors
The exact causes are unfortunately manifold, and are usually a result of a biomechanical imbalance in the structure of the knee. The following risk factors are not an exhaustive list but are considered to be major contributors to developing anterior knee pain:
Increased Q Angle: The Q angle is a relatively complex calculation that basically indicates the level of valgus in the knee (think the amount of “knock knee”) (it is a calculated as the angle between two lines: between a line drawn from the anterior hip joint to the centre of the knee cap and a second line from the centre of the kneecap to the insertion of the patellar tendon).
Weak or ineffective Vastus Medialis (VMO): Vastus Medialis is the inner-most quadriceps out of the four quadriceps. The quadriceps have a pulling effect on the patella and if there is an imbalance in the musculature, it often ends pulling the patella in an abnormal way. A weak vastus medialis will result in the outer quadriceps becoming too dominant, which will pull the knee cap to the outside of the leg. This can result in a painful compression of the kneecap, and a softening of the underlying articular surfaces.
Patellar Dysplasia or Patella Alta (high patella): An abnormally-shaped or abnormally high knee cap may induce excessive forces on the kneecap’s articular surfaces.
Ligamentous Laxity.
Female gender (possibly multifactoral, wider hips, higher Q angle, etc.).
Misalignment of the lower limb.
Abnormal pronation of the foot.
Tight Hamstrings or calf muscles.
Weak Hip Abductors.
Overtraining (Terrible "too's", too much, too soon, too often, too fast, with too little rest).
Treatment
Treatment for runner’s knee should start with a cessation or a total modification of the activity causing the pain. Activity cessation lessens the stress on the area and allows the body’s natural healing mechanisms to begin.
A programme of rehabilitation should start as soon as the pain is alleviated at rest. The rehabilitation programme should address identified key muscular imbalances; it should involve strengthening of the glutei muscles, core muscles, and the whole posterior muscular chain, and address over pronation issues in the ankle, stretch tight muscles (often hamstrings, hip flexors, calves).
Manual therapy is also recommended to accompany the rehabilitation programme, to continue to address the muscular imbalances by releasing tight muscles.
Tailored advice regarding restarting activity, running technique, shoes or orthotics is also key.
Do you knee have runner’s knee, or knee pain that doesn’t seem to shift? Contact me at claire@osteopilateslondon.com or book an appointment here to discuss your issues and how I can help!
