Such a Pain in the Knee Cap!

My first serious running injury was a pain in the knee cap! I was 17 years old running my fastest mile times during the indoor track season. This came to a halt with patellofemoral pain syndrome AKA Runner’s Knee.

Back in the 80’s the advice from the orthopedic specialist was, “Stop running.” Sadly, some physicians still give that same advice. But I say, no! Don’t hang up your run shoes. Seek an alternative. I wish I’d known back then that physical therapy was an option.

With early intervention, physical therapy can prevent or decrease time off. In chronic cases, modification or a break from training may be necessary, but physical therapy can help return runners back to sport earlier and healthier. 

My battle with Runner’s Knee was thirty years ago; now I regularly treat athletes suffering from the same condition. CoachAmyPT patient, Alyssa, suffered from Runner’s Knee and writes, “I’ve been doing the stretches you showed me, squatting properly and taking my pace slow.... excited to report that I ran my first pain-free three miles [in months].” Alyssa went on to run a half marathon this Spring. 

The first sign of Runner’s Knee is usually mild pain behind the knee cap after running. As it worsens, pain can become severe and occur after AND during running. A hallmark sign of this condition is pain in the knee while standing after sitting for long periods of time. Climbing up and down stairs can also be uncomfortable. 

There are many causes of Runner’s Knee including training errors and poor bio-mechanics. 

The pain in the knee is a result of altered positioning of the knee cap on the lower part of the thigh bone. This altered position means that forces are not evenly distributed on the underside of the knee cap; wear and tear and irritation result as it glides over the thigh bone improperly. Over time this can result in tears of the cartilage surface.  

What is causing this altered position? Weakness of the hips, imbalances in mobility such as tight Achilles and hamstrings, and poor dynamics at the foot with running are some of the possible culprits. A physical therapist that specializes in running injuries can accurately determine the contributing factors, and provide treatment that addresses them specifically. Proper diagnosis and treatment can also help prevent the injury from coming back.

Most running injuries are caused by a combination of things, and training errors typically do play a part in Runner’s Knee. Common errors include increasing volume and intensity too quickly, and lack of recovery between and within training seasons. A physical therapist with a background in run coaching and training can be helpful in assessing if training error is part of the puzzle, and work with you to make necessary changes. 

So what to do if you suspect you have Runner’s Knee? At the first sign of a problem, it is best to rest for a few days, take NSAIDS (nonsteroidal anti-inflammatory drugs), and apply moist heat (soak in Epsom salts). After a few days, resume activity gradually. If symptoms continue, seek evaluation and treatment as soon as possible. The longer this problem persists, the greater the potential for more damage, and the longer the rehabilitation process will take. Not all knee pain associated with running is due to Runner’s Knee, so an evaluation by a professional is important.

Note: Running while taking NSAIDS is not recommended.

Alyssa listened to her body, sought treatment, put in the work, and went on to run a half marathon this Spring. “I missed running so much and I feel more like myself than I have in months... thank you so much for helping me get back in the game.” -Alyssa. Don’t let a pain in the knee cap put an end to your running game either.