Your knees are the largest and most complex weight-bearing joint in the body, and they take on significant pressure and stress when you run. Specifically, the forces your knees are subjected to can rise to over eight times your body weight during running - which is precisely why our physiotherapists often see knee pain in runners. This is where the term runner’s knee came from - although this is a little misleading, as you don’t have to be a runner to experience this type of pain. While almost one-quarter of runners will develop “runner’s knee” pain in any 12-month period,[1] regardless of whether you’re a seasoned runner or are starting for the first time, our physiotherapists also see plenty of clients who prefer other sports like soccer, volleyball, basketball and dance.
Runner’s Knee: Patellofemoral Pain Syndrome
“Runner’s knee” is the nickname given to a condition called patellofemoral pain syndrome (PFPS). It is the most common cause of pain in the front of the knee, estimated to affect up to 23% of runners every year,[2] including almost twice as many women as men.[3] If you have runner's knee, you may notice:
- Pain behind your kneecap, as well as around your knee. With this said, many people find it difficult to pinpoint the exact location of the pain within the knee joint and go on to describe it as being either behind or at the front of the kneecap.
- Swelling around the knee
- Symptoms that come on gradually, are often prompted or intensified by activities such as walking down stairs, playing basketball, squatting and running,[4] because of how they repetitively bend and straighten the knee (or put significant force through the knee joint). You may also feel pain when walking again after sitting for prolonged periods.
What Causes Patellofemoral Pain?
Typically, when you bend and straighten your knee, your kneecap glides smoothly up and down a dedicated groove at the end of the thigh bone (femur). This keeps our movement fluid and painless, step after step, day after day. Unfortunately, if the kneecap mistracks, it moves irregularly and rubs against the end of the femur as the knee bends and straightens. This repetitive rubbing damages the bone ends, including the articular cartilage lining designed to protect the bones, leading to pain. This is why it’s called patello-femoral pain - pain caused by the patella rubbing against the femur.
The most common cause of the kneecap's irregular movement is a muscle imbalance, particularly where one side of your quadriceps at the front of the thigh is stronger or tighter than the other, which can move the kneecap over to one side. Hip position and foot posture (like having flat arches), as well as anatomical abnormalities of the knee, such as bone shape or other dysfunction, can also contribute.[5]
Treating Patellofemoral Knee Pain
Effectively treating runners' knee pain means going beyond what’s happening at the knee joint and looking at gait, biomechanics, lower limb characteristics, and the whole kinetic chain of movement from the foot up to the hip.
At PhysioCentral, we’ll start by performing a comprehensive assessment, which gives us a lot of answers and insight into the cause of your pain and where the deficits are present that affect how your knee is moving and being loaded by the body. We can then create a tailored treatment plan to help get the best results for your specific circumstances.
To manage your initial symptoms and discomfort, start by keeping your knee rested, elevated, applying ice, using compression and switching to low-impact activities like swimming and yoga to help relieve pain and prevent further knee damage.
To go beyond the symptoms and treat the underlying injury, you must address the real problem: your maltracking kneecap. This is where we’ll use your assessment results to identify exactly what happens as your knee bends and straightens, and then treat the problem. Typically, this involves strengthening the quadriceps and the muscles that abduct and rotate the hips and doing some proprioceptive training. We may also use some strapping, hands-on therapies, gait retraining, and we may even recommend orthotics to help support foot and leg alignment.
To support your recovery, here are three exercises you can do at home:
Side leg raises
- Begin by lying on your side on a comfortable mat. Rest your head on the arm that's in contact with the floor for support. Your other arm should be placed in front of your body, with your hand resting gently on the mat for balance.
- With your legs stacked on top of each other, slowly lift your top leg straight up toward the ceiling. Make sure to keep your leg in line with your body, avoiding any forward or backward movement. Lift your leg as high as you comfortably can without straining.
- Once your leg is raised, hold it in the air for 3 seconds, focusing on engaging your hip muscles. Then, slowly lower your leg back down to the starting position, maintaining control throughout the movement.
- Repeat this motion 20 times on one side, then switch to the other side and do another 20 repetitions. Complete three sets in total for each leg.
Sitting leg extensions
- Sit comfortably on a chair with your back straight and both feet flat on the floor. Ensure your thighs are parallel to the ground and your knees are bent at a 90-degree angle.
- Slowly extend one leg out in front of you, straightening it until it reaches a 90-degree angle with your body. As you lift your leg, make sure to engage your quadriceps (the muscles on the front of your thigh).
- Hold the extended position for 3 seconds, feeling the tension in your thigh muscles. Then, slowly lower your leg back down to the starting position, controlling the movement to avoid jerky motions.
- Perform 20 repetitions on one leg before switching to the other leg. Complete three sets of 20 repetitions for each leg.
Wall sits
- Stand with your back flat against a wall, ensuring your feet are positioned shoulder-width apart. Step your feet forward so they are about 60cm (or roughly 2 feet) away from the wall. Your back should remain in contact with the wall throughout the exercise.
- Slowly slide your upper body down the wall, bending your knees as you go. Continue sliding until your thighs are parallel to the ground and your knees are bent at a 90-degree angle. Your lower legs should also form a 90-degree angle with the floor, and your knees should be directly above your ankles.
- Hold this seated position for 20-30 seconds, engaging your thigh and core muscles to maintain stability. Keep your arms folded in front of you or by your sides as you hold.
- After holding the position, slowly rise back up the wall to the starting position. Repeat this exercise three times. As you build strength, gradually increase the hold time by 5-10 seconds with each session.
Physio Treatment For Runner’s Knee Pain
If you’re experiencing knee pain, whether you’re a runner or not, we’re here to help. Book your appointment by calling us at +852 2801 4801 or book online here.