Please note: I am not a medical professional or health/fitness expert. I am an amateur runner who has forgotten all but a few bits and bobs from my high school Anatomy & Physiology class. Any tips mentioned in this post are based either on what my physio has given to me, to treat my own specific dodginess, or on articles I’ve read, and may not be best for everyone. Be sure to consult with a doctor/physio/trainer/someone more qualified than I am if you are having knee dodginess of your own!
Back in May I was diagnosed with patellofemoral pain syndrome, or “runner’s knee.” It’s been two months since that diagnosis, I’ve just finished my second course of physical therapy, and my knee is still a little dodgy. This makes me unhappy.
Readers, it’s time for me to pull on my big girl pants and kick this knee pain to the curb. I have dodgy motivation most of the time, and I’ve been half-assing my recovery. Until now. I declare: this week is when I will make the change for real!
To better understand what I’m dealing with, let’s back up and look at what this is all about.
What is Runner’s Knee?
Runner’s Knee is patellofemoral pain syndrome, patellofemoral referring to the patella (kneecap) and femur (thigh bone). Add that to “pain syndrome” and it sort of explains itself. Basically, it occurs when the kneecap doesn’t track correctly in its little groove at the bottom of the femur, leading to symptoms like popping/cracking, pain, and the knee giving out.
According to Runner’s World, “The stress of running can cause irritation where the kneecap (patella) rests on the thighbone. The resulting pain can be sharp and sudden or dull and chronic, and it may disappear while you’re running, only to return again afterward.”
In my case, it’s been presenting itself as pain around my right kneecap that sometimes hurts when I run (sometimes it doesn’t) and sometimes hurts after I run (or sometimes it doesn’t, though it usually does). What drove me to call the doctor back in May was the swelling around my knee that wasn’t really going down despite a steady regimen of anti-inflammatories and ice, as well as the pain.
What Causes Runner’s Knee?
It could be any number of things, or even a combination. According to that same RW article, the following are possible causes:
- Bio-mechanical issues with the patella (the size or natural positioning of the kneecap may affect the way it tracks with the femur)
- Very high arches in the foot (less cushioning = more jarring of the knee when running)
- Flat feet/no arches and/or knees that turn in, pulling the kneecap sideways
- Tight and/or weak quads and/or hamstrings
- Worn cartilage in the knee
According to my orthopedist, my quads are super tight and likely pulled the kneecap out of alignment with the femoral groove. My PT agreed with that assessment, and after examining me, added that I also have tight/weak hamstrings, I have flat feet, my knees point in, and I’ve had chronic ankle problems that may have also contributed to instability in the knee and other parts of my leg.
Basically, I was surprised that it took me this long to come down with Runner’s Knee, given that I had so many factors conspiring against me!
How to Prevent Runner’s Knee
For those of you lucky enough to have escaped this particular brand of knee dodginess thus far, rejoice! This is a fate to which you don’t have to be resigned! (Also, I’m jealous of you right now.) It seems that it’s quite easy to keep this ailment at bay, so long as you behave like a normal, conscientious person (i.e. not me).
Again, from the wisdom of RW:
- Make sure you’re wearing properly fitted running shoes
- Don’t increase your mileage by more than 10% a week
- Gradually introduce hills to your workouts
- If able, break up the pavement-pounding by running occasionally on grass or dirt
- Do strength training, especially in your quads
- Did I already mention stretching? Be sure to stretch out your quads, hamstrings, and calves on the reg
If you’d rather follow a list that allows you to ride the waaaaaambulance like me, feel free to follow the Slow and Steady(ish) Guide to Messing Up Your Knee (TM):
- Rarely stretch after running, and if you do, regularly forget major muscles
- Strength training? Who has time for that? Just run like the wind, grasshopper!
- Eat hills for breakfast, lunch, and dinner… or, you know, just decide all of a sudden that you want to do hill training and tear up a few with reckless abandon
- Have flat feet but don’t wear orthotics
- Be oddly proud of your pointy-in knees and let them track inward all they want, especially when you climb stairs
- Panic that your first half marathon is getting ever closer, so jump up real quick to 10 miles in your training runs. It’s more important that you hit 10 miles than that you hit those 10 miles gradually
- Have a job that makes you sit all day. Grumble about your tight hip flexors and hamstrings but never stretch
How to Treat Runner’s Knee
Did you follow the Slow and Steady(ish) Guide to Messing Up Your Knee (TM)? Why, you fool?! Have you not read my blog posts of woe?? Nevermind, it happens to the best of us. Let’s see what RW has to say on treatment:
- Cut back on mileage immediately
- Avoid doing anything that requires knee-bending
- Stick to flat surfaces when possible, avoiding downward slopes as much as you can
- Use a smaller stride, especially on hills
- Consider orthotics
- See a doctor
I may add the following (please see the disclaimer at the top of this post), based on my experiences:
While you’re experiencing pain:
- Ice your knee. I was told to do it 2-3 times a day at first, and then whenever I felt discomfort later on.
- Take anti-inflammatories like ibuprofen (Advil) or naproxen (Aleve) if your knee is swollen (if you’re okay taking those pills… talk with your doctor if you aren’t sure)
- Rest. I know, I know, resting is terrible when you just want to run. My orthopedist recommended at least 1-2 weeks of no running, and my PT wanted me to avoid running until the swelling went down.
Once you’re ready to start running/using your knee regularly again:
- Take it easy! Ease yourself back into running – don’t take off sprinting or running hills or banging out 10 miles immediately, no matter how badly you want to. My PT had me run gently on a treadmill – 2 mins walking, 2 mins running, 2 mins walking, etc. for 10 minutes, then bumped me up to 3 mins running, then 4, etc. Let the pain (or lack thereof) be your guide, but don’t overdo it.
- Stretch, stretch, stretch, stretch, stretch!!
- Ice your knee after you run, after you do any exercise with it, or any time it gets painful
- Add strengthening exercises into your routine. David over at Running with Faust recently posted some exercises he found online, and they happen to correspond pretty much exactly to what my PT has been having me do, so they might be worth exploring:
How I Aim to Defeat My Half-Assery of a Recovery
-My PT recommended that I stretch twice a day, focusing on hamstrings, quads, IT band, and hips. I will do this. I will also stretch my calves because they are notoriously and forever tight.
-Those rehab exercises in those images up there? I do them at PT twice a week, and my PT recommended that I do them 3 times per week on my own. I have been doing this, and will continue to do this.
-Ease myself back into running. I mentioned in my last post that I’m considering doing Couch to 5K to force myself to take it easy as I make my glorious return. My friend Julie, who is also coming back from a knee injury, has agreed to do this with me (she rocks!). Until that starts up, I have joined the Shammies twice at their Tuesday track workout, not to do speed work with them, but to run gently in the outside lane while they sprint past me. I miss them, and the weekly workout is good structure for me.
This was my workout two days ago:
I walked a few laps, then gently ran one lap, then walked one lap, then ran one lap, etc., regularly consulting with Simon to make sure I wasn’t going too fast, and alternating directions so that I wasn’t putting stress on only one side of the knee. I managed to keep my running pace between 11:00 and 12:00 mins/mile [side note: it is constantly mind-blowing to me that 11:00 feels easy! It wasn’t that long ago that 11:00 was super speedy for me.] with a few breaks for water and stretching my tight hamstrings.
I made myself stop as soon as I hit 2 miles, then took my time and stretched everything up real good while the Shammies finished up their workout. Despite a few twinges of pain while I ran, I felt pretty good, and it felt great to run with(ish) the Shammies again! I’m looking forward to C25K too… as The Blog Runner mentioned recently, it will be a good confidence builder as well as a gentle way to return to running regularly.
Any Runner’s Knee prevention/treatment tips to add?
How do you return to running from injury? Have you used C25K?