It was cold, and I was exhausted- but what was going on with my legs? I could feel the panic slowly working its way up from my knees to my brain. At 30 years-old, I was finally starting to feel the effects of aging.
My knees hurt.
I suddenly started to think back to all of the long runs and all of the soccer games; the worn out, worn down Adidas trainers that I had refused to throw away after college and still wore for trail runs because of the ‘natural’ feel they provided. I was also on three different soccer teams at the moment: THREE.
Maybe this was a sign. Had I done too much? I reflected on my athletic life , desperately trying to justify all of the reasons why I didn’t need to quit soccer; justifying why I continued to run in worn out shoes despite having two practically untouched pairs, collecting dust in the closet.
I ran through a list of possibilities for the pulsating, aching pain. Had I gained weight? Maybe I should’ve been taking those stupid D vitamins after all. Was this the beginning of osteoporosis? I thought about the couple of silver hairs that had managed to proudly push their way through the massive amount of dark hair in the front of my head. What would be next- breaking a hip?
Runner’s Knee- aka: Patellofemoral Pain Syndrome
While runners sometimes refer to aching knee pains as “Runner’s Knee”, most will hesitate to call it an actual medical condition. Medical experts, however, have no issue making this distinction, citing Runner’s Knee as a common phrase used to refer to any number of loosely related medical conditions that can cause pain to or around the front part of the knee (also known as patellofemoral pain).
Medical conditions, which may cause Runner’s knee include:
- Patellofemoral Malalignment (Kneecap misalignment)
- Chondromalacia Patella (Soft cartilage under the knee cap)
- Anterior Knee Pain Syndrome (Pain occurring in the front of the knee cap area)
- Iliotibial (IT) Band Syndrome (Pain on the outside of your knee)
- Baker’s Cyst (Pain and swelling behind the knee)
Symptoms of Runner’s Knee
- Dull, aching pain under or around the front of the kneecap (patella) where it connects with the lower end of the thighbone (femur)
- Pain when walking up or down stairs
- Pain when kneeling
- Pain when squatting
- Pain when sitting with a bent knee for a long period of time
How Your Knees Work
The knee cap is medically referred to as the patella. It consists of a thick, circular bone which covers and protects the front of your knee joint. It is also the largest sesamoid bone (bone embedded within a tendon) in the human body. When you are running or walking, several forces act on the patella to provide stability and keep it tracking properly so that you are able to move in a smooth manner [source].
One of the most common misconceptions about the human knee is that it only moves in a vertical position. In fact, it not only moves vertically; it also rotates and tilts as well!
Causes of Runner’s Knee
Outside of the medical conditions that can cause Runner’s Knee, there are any number of other, outside factors that can contribute to the prolonged aches and pains you feel around your knees. These causes include some of the following:
OVER-STRETCHED TENDONS or OVERUSE or OVERTRAINING
If your day-to-day activities involve a lot of knee-bending, then this repeated movement may cause the nerves in your kneecap(s) to become irritated. With overuse, you may also find that you’ve overstretched the tendons in your knee, which can result in that aching, uncomfortable feeling during or after you run.
Over-training is definitely a problem that you come across on college cross country teams as well as with those who try to increase their running mileage too much or too fast without the proper base point. If you’ve recently added a ton of mileage to your training regimen (i.e. going from 30 miles a week to 50 or 60 miles a week), you may be pushing it. The American Council on Exercise recommends adding no more than 10 percent to your mileage count each week. This gives your body a chance to acclimate and make a smoother transition.
IMPROPER RUNNING FORM or MISALIGNMENT
When it operates efficiently, your body is similar to a well-oiled machine. When it comes to running, your knees move up and down in a small area inside of your thigh bone. In good form, this movement should be smooth and comfortable with each step that you take. However, if your kneecap moves outside of its track, or rubs against its sides, you may soon find yourself in pain- especially when you consider the fact that the average runner takes approximately 1,000 steps per mile. The result? The cartilage that surrounds your knee and keeps it cushioned will become worn down, which may lead to Runner’s Knee [source].
WEAK THIGH MUSCLES
While runners will often have well-developed hamstring muscles, one of the more common problems related to knee pain stems from the front of the thigh in the often overlooked and underdeveloped quadricep muscle. As the name suggests, there are four different muscles that make up the quadricep. Of these, the most important muscle that runners should pay attention to is the Vastus Medialis. Statistically, this muscle is the most underdeveloped compared to the other muscle heads. Also, this muscle is extremely important to your body’s range of motion as it attaches further down the leg than the other muscles that make up the quadriceps. Therefore, it has greater responsibility for terminal range of motion at the knee [source].
MUSCLE TIGHTNESS or INADEQUATE STRETCHING
One of the things people tend to notice about runners is their hamstrings, or the back of their thighs. Your hamstrings are the muscles responsible for flexing the knee. If your hamstrings are tight, this will place more stress on your knees, causing an increase in the pressure between the patella and the femur (knee and thigh).
Unless you are involved in other sports, such as soccer or cycling, running is (for the most part), a repetitive activity because you are using the same muscle groups over and over, in the same manner each time. Because of this, the ligaments and tendons in your hamstrings, quads and even your glutes can become shortened as time goes by. This is why it is important to make sure that you spend some time stretching. Most runners will be able to get away without stretching before running (myself included), but you should ALWAYS make time for stretching afterwards. Plan to set aside at least 10-15 minutes.
Also known as Pes Planus Pronation, or ‘foot pronation’, having flat feet may cause your body to compensate by forcing your ankle to roll medially, or inward. This then causes a chain reaction whereby your femur or your tibia will also rotate internally, putting more stress on your knee joint and upsetting the natural balance of the patellofemoral mechanism (the knee movement process).
Preventing Runner’s Knee
As you may have already guessed, stretching goes a long way in terms of injury prevention. Make time for it before you exercise and definitely after you’ve finished exercising.
STAY IN SHAPE.
This shouldn’t be confused with ‘overtraining’. Rather, if you are overweight, you may need to take it easy at first when trying to lose the weight. Try water aerobics or the elliptical to start. Think of non-weight bearing exercise machines and tools to help you lose those first few pounds before you start pounding the pavement. Your knees will thank you.
INVEST IN THE RIGHT TRAINING GEAR.
Barefoot running isn’t for everyone. Invest in a sturdy pair of running shoes- and don’t just rely on gut instinct. Go to an actual store that specializes in running shoes so that you can be fitted by a professional who actually knows what they are talking about and can provide you with valuable information about the kind of shoe support that you need based on your body type.
STUDY YOUR RUNNING FORM & WORK TO IMPROVE.
It’s ok to run hills at the park or do barefoot training in the sand every now and then. However, as a general rule of thumb, you should always try to stick to smooth, clear surfaces that provide some level of cushioning. Think of grassy paths, dirt roads, etc. Also, when running, pay attention to your running form. Listen to your breathing; look at where your arms are hanging. Lean forward slightly, and keep your knees bent.
When running down a steep hill, NEVER run straight down. Instead, criss cross or walk. When running up a steep incline, bring your knees to your chest and get on your toes. Not sure what the heck you are doing? Find a coach or a knowledgable running buddy who can look at your form and give you some pointers.
Treatment for Runner’s Knee
R.I.C.E. (Rest. Ice. Compression. Elevation.)
Sometimes the best medicine is the simplest. If you’re experiencing pain, it may be a sign that you need to give your body a rest for a while. Ice your knee(s) only if you notice swelling; and as a general practice, it’s a great idea to incorporate elevation into your post-run stretching routine. To do this, simply lay on your back on the floor and prop your feet up against a wall at a near 90-degree angle for a few minutes. Keeping your knee elevated above your heart helps to improve circulation and may help to reduce pain and/or swelling.
ORTHOTICS or ARCH SUPPORTS
Custom orthotics may help those who suffer from flat feet by working to improve pronation issues.
TAPE or BRACES
Using a knee sleeve, brace or simply taping your knee may help to keep the patella in better alignment, though the information on this is relatively controversial. It is advisable that you speak to a medical professional for more information on the effectiveness of this treatment for you.
Weak thigh muscles are often linked to knee (joint) problems. After applying the R.I.C.E. theory, you may want to speak to your physician about incorporating some basic strength training exercise into your fitness routine to help you strengthen the muscles around the knee. Your doctor may also prescribe you a cross-training program to help you achieve this result.
Ibuprofen may be used in the event that there is swelling or pain, but if you find yourself relying on it more and more, it may be wise to see a doctor.
On rare occasion, if non-surgical methods fail to resolve the problem, or if the problem gets worse, surgical treatment may be necessary. Two common treatments include:
- Arthroscopy- Small pieces of damaged cartilage are removed from the kneecap via a small incision and an instrument called an arthroscope.
- Realignment- The kneecap is realigned to reduce pressure on the supporting tissue/cartilage surrounding the knee.
No Knee-d to Panic
I hate stretching with the kind of passion that I wish I could plug into some other area of my life.
I am a self-proclaimed workaholic who has also chosen a career path as a web content writer- a deadly combination as it often means that I willingly park myself behind a desk for hours on end when I’m not running or playing soccer.
I sometimes push myself a little too far- either by not getting enough sleep, playing in 3 or more soccer games a week, going for random 11-mile runs after a dry spell…OR all of the above.
Sometimes, you can be your own worst enemy. Sometimes, when your body is in pain or uncomfortable, it may be trying to tell you something.
Perhaps, it’s time you started listening.
- Clark, J. Knee Pain. (2013). Cool Running.
- Coyne, J. The most important muscles to strengthen for running-Part 3: Quadriceps. (2012). Joseph Coyne.
- Juhn, Mark S. Patellofemoral Pain Syndrome: A review and guidelines for treatment (1999). American Academy of Family Physicians (AAFP).
- Runner’s Knee (Patellofemoral Pain). 2007. American Academy of Orthopaedic Surgeons (AAOS).