Undoubtedly one of the most common complaints from runners, knee pain can play havoc with your training schedule or leave you on the sidelines.
Knee pain is a common and frustrating issue, suffered by both new and experienced runners alike. It is common to hear a diagnosis of “Runner’s Knee”, which covers a myriad of conditions and may be caused by a number of different factors:
Running style
Loading capacity
Conditioning of the surrounding soft tissue
It is important to be assessed by a chartered physiotherapist in order to rule out any serious pathologies, such as infection or any systemic illness. This is when the physiotherapist will ask you about your previous medical history, any recent weight change and about the nature of your pain.
You may be diagnosed with one of the following conditions associated with running:
Patellofemoral Pain Syndrome (PFPS) / Anterior Knee Pain
This presents as pain at the front or underneath the knee cap, which worsens with running and using stairs. Running while the knee cap is in a misaligned orientation, is thought to contribute to this condition. This change in biomechanics can irritate structures, such as cartilage, underneath the knee cap.
This can be improved by decreasing the distance covered for a short while, until symptoms settle, taking anti-inflammatories, and keeping active by beginning specific strengthening exercises (Barton et al, 2015).
Patellar Tendinopathy
This presents as pain on the front of your knee, towards the top of your shin. This also worsens by running, using stairs, and on palpation of the patellar tendon. This is an indication that there is too much force exertion on the patella tendon.
A good strengthening and stretching protocol for hamstrings and quadriceps can help improve your symptoms, while you stop running for a period of time determined by your therapist.
Iliotibial Band Syndrome
This presents as a more lateral pain from your hip to the outside of your knee, following the fibres of the iliotibial band. This will normally occur during a run. A small fluid filled sack called the ‘bursa’ at the outside of the femur and beneath the iliotibial band, can become irritated and inflamed. This may cause a pain or a burning sensation at the lateral aspects of your knee.
You can continue to run with this, as long as it does not cause changes to your running style. You can help to improve this with targeted strengthening exercises and by having your gait assessed.
What to do about it?
If you are having pain during and at the end of the run, applying ice to the knee can help to settle down your pain symptoms. It is best to do this for 20 minutes with a bag of ice wrapped in a wet cloth or towel. This can provide temporary relief, if there is inflamed tissue under the kneecap, or at the front of the knee.
Having a good stretching programme before and after your run may be helpful in prevention of excessive post-run pain. This would involve stretching the quadriceps at the front of your leg, and the hamstring and calf muscles at the back of your leg.
It is likely that, in a deconditioned runner or experienced runner alike, a specific exercise programme can help to strengthen the muscles around the knee joint to reduce symptoms in running (Barton et al, 2015).
If you notice swelling or severe pain at your knee post-run, you should book an appointment with a physiotherapist for further guidance.
References:
The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning
Christian John Barton, Simon Lack, Steph Hemmings, Saad Tufail, Dylan Morrissey
