Rodes City Run: Runner’s Knee

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The second race of the Triple Crown is now behind us, and what a beautiful day it was for racing.  For those of you who completed the race, congratulations and good luck on the final leg, which will be the Papa John’s Ten Miler.  As I wrote about in my last post, I had some pacing problems in the first race so I paid special attention to that this time and I feel I did a much better job.  My pace fluctuated no more than 10 seconds per mile for the entire race, and I felt much better at the end.  When I was looking up results on the race’s official website, I noticed they had links to go back all the way to 2002.  It just so happens that the last time I ran the Rodes was in 2002, so I looked up my time and I was pleased to find that my time this year was only 9 seconds slower than 10 years ago!  They say you’re only as old as you feel (and I feeling it more during this training than I did 10 years ago, that’s for sure).  Again, I would like to thank all the supporters who cheered us on from the roadsides, and give a special shout out to part of our Norton running team Dan Delph, who was full of energy on the side of Cherokee ringing cowbells and passing out drinks.

I wanted to talk this week about a very common condition that plagues runners – so common in fact that it is usually called “runner’s knee”.  What is runner’s knee?  The medical moniker is patellofemoral pain, or patellofemoral pain syndrome (PFPS).  Patellofemoral pain, or kneecap pain, is characterized by pain in the anterior aspect, or front, of the knee.  It is generally caused by irritation of the soft tissues around the kneecap, or of the cartilage in the kneecap joint itself.  Many factors can contribute to patellofemoral pain, including:

  • Trauma or injury to the kneecap or its cartilage
  • Overuse or over-stress of the kneecap joint
  • Malalignment of the kneecap
  • Dislocation or instability of the kneecap
  • Tightness, weakness, or imbalance of the thigh muscles
  • Flat feet (pes planus)

The symptoms of patellofemoral pain are generally a dull, aching pain under the front of the knee just behind the patella.  This generally occurs with flexed-knee activities, including:

  • Squatting
  • Kneeling
  • Walking up or (especially) down stairs or hills
  • Sitting for long periods of time with a bent knee
  • After running (especially hills)

Here are some tips to help prevent patellofemoral pain, especially if you are a runner:

  • Stretch – Tightness of the quadriceps muscle can lead to patellofemoral pain, so stretching before and after runs can help minimize the chances of developing runner’s knee.
  • Avoid excessive hills – Overtraining, especially excessive hill running, can lead to patellofemoral pain.  Pay special attention to running down a steep hill, as this generates immense stress on the patellofemoral joint.  Slow your pace and for very steep hills run in a zigzag pattern, not straight down.
  • Avoid or modify squats and lunges – Many times a patient will present with patellofemoral pain after starting an exercise routine including squats, lunges, step-ups, and/or knee extensions.  All of these activities place tremendous stress on the patellofemoral joint, and I generally recommend either avoiding them, or modifying them to keep knee flexion at 45° or less.
  • Stay in shape – Good conditioning, particularly of the thigh muscles, is important in preventing patellofemoral pain.  Controlling your weight is a major factor as well.  Biomechanical studies have shown that during a full deep squat, compressive forces across the patella approach six times body weight – you do the math.

Treatment of patellofemoral pain syndrome is almost always non-surgical.  In addition to the activity modifications described above, the RICE protocol (Rest – Ice – Compression – Elevation) can be very effective in treating the acute symptoms after activity.  An anti-inflammatory can also be helpful in the initial stages to control the inflammation and swelling of the anterior knee structures that are responsible for the pain.  Physical therapy is useful in cases where these other treatments do not eradicate the symptoms.

Occasionally, there is a more anatomic cause of the patellofemoral pain.  A focal cartilage lesion behind the kneecap or in the groove where the kneecap slides (the throchlea) can lead to patellofemoral symptoms.  Large, symptomatic lesions may need to be treated surgically to help restore the cartilage surfaces.  Malalignment of the patella can also lead to patellofemoral pain, and in mild cases can be treated with taping or bracing.  In more severe malalignment, especially if the patella actually dislocates out of the trochlea, surgical intervention may be necessary to correct the problem.

Again, good luck with your training and I hope to see you at the Papa John’s Ten Miler.