Ouch! What's That Pain In My Knee?

Of all of the “Big Five” running injuries, “Runner’s Knee” is perhaps one of the most vexing – and it effects more women than men runners for reasons that remain unknown, but is likely due to anatomical differences in women that cause increased lateral forces on the patella.

What It Feels Like
This condition presents itself as pain around, and frequently behind, the kneecap that becomes more acute when running downhill or walking down flights of stairs. Oftentimes you will notice that your knee becomes stiff after sitting for long periods of time and you might even hear a crunching or clicking sound when you bend or extend your knee.

You see, the undersurface of your kneecap or patella is covered with a smooth layer of cartilage. Normally, this cartilage glides easily across the surface of the knee when you are bending it. However, in many runners, the kneecap tends to rub against one side of the knee joint more than the other, causing the cartilage surface to become irritated. Voila! Runner’s Knee!

It is generally thought that relatively weak thigh muscles and a lack of proper foot support cause this imbalanced condition. It’s your thigh muscles that keep your knee in place, preventing it from jumping off track, and unfortunately running develops the hamstrings (back of your thighs) more than your quads. This frequently contributes to your knee mis-tracking when you run. Consider the fact that you bend your knees a thousand times for every mile you run and you can see the potential for trouble. Also, if you suffer from Runner’s Knee, it is likely that you are overpronating or supinating when you run, again causing an imbalance in which your knee will be pulled to one side or the other.

Like several of the other “overuse” injuries, Runner’s Knee can be aggravated by too rapid increases in mileage, by running lots of hills, and by repeated workouts on canted surfaces (like the side of the road).

What To Do
Most runners are relieved of symptoms through rest, ice and the use of OTC anti-inflammatory drugs like aspirin or ibuprofen.

Immediately after your run, ice your knee for 10 minutes (a bag of frozen peas works nicely), and take an anti-inflammatory after you’ve eaten. You may also want to use a heating pad on the area for about 30 minutes just before you go to bed. Dare I say it, but if you are experiencing constant knee pain you are going to need to give your knee several weeks of complete rest while regularly icing three times a day. This will give the area time to repair damaged tissue Resume your  training SLOWLY and carefully, gradually working back into your mileage.

Longer term, emphasize exercises that strengthen your quadriceps with the idea of balancing their strength to that in your hamstrings. Also, include stretches that gently increase flexibility and strength in the area,  including the quads, hamstrings, ITB and glutes. You also want to wear running shoes that provide the proper amount of motion control and support for your feet. If you can, have your form analyzed at your physical therapist’s office or at a good specialty running store to ensure you are fitted for the appropriate shoes.

Whenever possible, run as close to the center of the road as you can or avoid canted roads altogether, minimize repetitive downhill and track workouts…and of course…obey the 10% rule when it comes to increasing mileage.

The good news is that 90% of runners fully recover from Runner’s Knee after rest and rehab as described above. Of course, if pain persists and you are unable to resume training pain-free it’s time to visit your doctor.

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