Ask the Osteopath: Runner’s Knee

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As an Osteopath especially working in a sports clinic at a Running shop, I see runners come in with knee pain a lot. The most common cause of the knee pain is often Runner’s Knee or Patellofemoral pain.

What is Runner’s Knee?

Runners knee is also called Patellofemoral Pain and is the most common running injury and twice as common than any other running related injury. It is particularly common in runners under the age of 25 as well as in women, Beiser et al (2011). Unfortunately it is often a chronic condition with patients still reporting it 4 years later!Patellofemoral pain is also linked to an overuse injury and more common in marathon or ultra marathon runners, Nielson et al (2013).

What are the symptoms of Runner’s knee?

The pain is normally felt round the front of the knee either underneath or around the kneecap or Patella. The pain is normally when you are weight baring and is often from squatting, going up stairs and of course running. The kneecap is seen as a lever and helps in the movement of the patellofemoral joint, quadriceps and patella tendon, which are all attached to the kneecap, Dixit et al (2007).

What element contribute to getting Runner’s Knee?

There are several different elements that can contribute to developing runners knee these include the balance and strengths of your quadriceps, foot placement and running pattern.

Your quadriceps’ are a group of four muscles at the front of your thigh and the balance and strength of them individually is very important in their function. If one of the muscles say the one at the outside of your thigh is stronger it could cause you knee cap to be pull more towards the outside of your thigh rather than straight down when tense your quadriceps.

The effect of this can increase the pressure and decrease the amount of space in the knee as well as the force at which you foot strikes the ground. These can all contribute to why you experience the pain, Fulkerson & Shea (1990). Research by Cowan et al (2002) points to the outside quad actually starting to work before in the most inner quad muscle when you have this type of knee pain. Furthermore if your inner quad is weak you are more likely to dislocate or have an unstable kneecap, Sakai et al (2000).

You running pattern or gait could be predisposing you to this injury. For more information check out my blog post on the biomechanics of running. It is important to identify, if this is the case as you may need to see a podiatrist or Orthotist for orthotics to help correct this. If you say have flat feet or a low arch it can cause your knee to roll in when you take a step which can cause the outside muscle of your quads to have to work harder to bring the knee back into a neutral position. Furthermore it has also be shown in paper by Kulmala et al (2013) that by changing from landing on the ball of your feet than your heel can also reduce the pain by 15%. Similar studies and results have also been shown from have a smaller stride when you run both affecting the mechanical pull from the quadriceps that can contribute to the pain, Wilson et al (2015).

So I have Runner’s knee, What can I do to reduce the symptoms?

An exercise program is vital to the recovery of runner’s knee or patellofemoral pain. It may be necessary to reduce or stop the activities that are aggravating the pain including running and squat based exercises. This doesn’t mean you have to avoid doing exercise altogether depending on your situation it maybe possible to substitute with swimming or cycling through cross training as an alternative to keep your fitness up while you recovery from the injury. A majority of patients find ice being helpful in reducing symptoms and can be placed on the knee for 4 minutes wrapped up in a kitchen cloth.

An exercise program is vital to the recovery and rehabilitation of runner’s knee or patellofemoral pain. It may be necessary to reduce or stop the activities that are aggravating the pain including running and squat based exercises. This doesn’t mean you have to avoid doing exercise altogether depending on your situation it maybe possible to substitute with swimming or cycling as an alternative to keep your fitness up while you recovery from the injury. A majority of patients find ice being helpful in reducing symptoms and can be placed on the knee for 4 minutes wrapped up in a kitchen towel.

The exercises found in this document are generic for the typical patient with patella femoral pain and may not be suited to every patient’s circumstances.

Exercises for Runner’s knee:

Squat with medicine ball rotation

Squats with Rotation:

Place a ball or foam roller between your legs and as you drop down to a squat position rotation your knee over to the other side. This can be done to both sides or to one depending on your situation

Wall Squat

Wall Squat against a swiss ball:

Place the ball at the curve of your lower back with your hands outreached. Drop down so your knees are at right angles with your knees over your toes and hold for 10 seconds before returning to standing.

Single leg glue bridge

One leg hip lifts:

Lie on the floor with your knees bent. Slowly lift up your hips so it is in a diagonal plane with your knees. Once in this position lift up one leg straight into the air and hold for 7 seconds before returning to the floor.  You can repeat this 5 times and then switch to the other leg and do the same thing.

wobble board proprioception

Standing on one leg on a wobble board:

This exercise to work on your proprioception and balance of your ankle. It would be ideal to stand on a wobble board on one leg. However any uneven surface would be suitable you can start with a pillow and work your way up as you find it easier.

single leg Lunge

One leg lunge:

Start standing and move one leg forwards so your knee is over your toes then step forward and return to neutral. You can do this exercise 10 times on one leg before switching over to the other side.

Squat

Squats with changing angles:

Start with a normal squat with you feet pointed straight in front of you, then start to alter the angle of you feet each time so that you target slightly different parts of the quadriceps muscle. This will help to strengthen the imbalance between the individual quads.

You can download this guide at: The A State of Health Clinic’s Website.

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