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Do you suffer from Runners Knee?
Runner’s knee is a term used to refer to a number of medical conditions that cause pain around the knee (patellofemoral pain). These conditions include patellofemoral malalignment, chondromalacia patella and IlioTibial (IT) Band Friction Syndrome. It is common in sports such as running and cycling where the knee is overused due to the repeated bending and straightening of the knee.
Patellofemoral pain syndrome got its nickname ‘Runners Knee’ for an obvious reason. 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. It may be traced back to muscle imbalance with poorly conditioned quadriceps and tight hamstrings. Weak and unbalanced quadriceps are not able to support the patella, leading it to track out of alignment, and inflexible hamstrings can put pressure on the knee.
Patellofemoral pain may be the result of irritation of the soft tissues / strained tendons around the front of the knee. Other contributing factors to patellofemoral pain include overuse, muscle imbalance and inadequate stretching. The kneecap can also be out of alignment and can cause excessive stress and erosion of the cartilage of the kneecap / under the patella called chondromalacia patella which causes pain in the underlying bone and irritation of the joint lining.
The ITB can rub on the side of the knee causing friction leading to inflammation. If the ITB is tight, then the friction is increased and more evident in marathon or other long-distance runners. Other factors such as leg length discrepancy, an abnormal pelvic tilt, and “bowlegs” (genu varum) may cause iliotibial band syndrome because of excess stretching of the IT band across the femoral lateral condyle. Other factors to be considered include for example, running on one side of the road only since most roads are higher in the centre and slope toward the edge, running on only one side will cause one leg to always be downhill from the other. Normally pain is located on the outside of the knee joint but may radiate up the thigh or down the outer side of the shin. The pain from runner’s knee is normally only present during activity and settles when resting but sometimes pain is present when performing everyday tasks with knee flexing, especially going up or down steps.
Physical examination may reveal general tenderness over the site of the iliotibial band insertion at the knee joint, and specific tender points may be felt over the lateral femoral condyle where the bursa is located. The iliotibial band may be tight, determined by the Ober test. The examination may find some weakness or imbalance of the quadriceps muscles and the hamstring muscles located in the back of the thigh that flex the knee.
- Foot imbalance overpronation (feet rotate too far inward on impact) – can cause the kneecap to twist sideways (over pronation) and can also lead to the knee cap being imbalanced and thus producing knee pain. Sometimes this condition can be aggravated by a sudden increase in mileage or speed.
- Muscle imbalance – between weak quadriceps and tight hamstring and iliotibial band. When the leg muscles are imbalanced the knees go off track causing the cartilage to grind away at the knee cap. Weak quadriceps (normally weak Vastus Medialis) are usually caused by the very strong hamstrings overpowering them. This causes the knee cap to be imbalanced as the weaker quadriceps are unable to support the knee cap and prevent twisting and pulling of the knee cap.
- Running on uneven surfaces, cambered surfaces.
- Incorrect or worn shoes. Most runners know that the life of a pair of running shoes is typically only about 300 miles.
- Wide Hips – (Reference a ‘q’ angle). Some of the reasons that contribute to the higher q angle are ladies with wide hips, short thighs and people with knock knees.
Symptoms include: – A dull, aching pain, crepitus (grinding noise) under or around the front of the kneecap (patella) where it connects with the lower end of the thighbone (femur). Pain occurs when walking up or down stairs, kneeling, squatting, and sitting with a bent knee for a long period of time. Pain is most severe after hill running.
Diagnosis (by a GP) is usually by consultation and medical history regarding symptoms and type of sports undertaken and which activities aggravate knee pain. Other information will include frequency of training activities, surfaces run on etc. The physical examination will include a check of the alignment of the lower leg, kneecap, and quadriceps; knee stability, hip rotation, and range of motion of knees and hips; under the kneecap for signs of tenderness; the attachment of thigh muscles to the kneecap; strength, flexibility, firmness, tone, tightness of the Achilles etc.
Other diagnostic equipment may be used such as X-rays, magnetic resonance imaging (MRI) and computed tomography (CT) scans.
Treatment depends upon the particular problem causing the knee pain, and is usually nonsurgical. Sports Massage treatments are a good option for many patients with iliotibial band syndrome. IT band treatment is often painful as you are treating the fascia and not muscle. The therapist will incorporate stretching the IT band which is not always that easy! Some therapist may try to assess running technique and style to look for an underlying biomechanical cause of iliotibial band inflammation. This may include gait analysis as well as flexibility. A change of shoes or an orthotic shoe insert may also be needed.
It is advisable to stop doing any activities that hurt the knee, and not start again until they can be done again without any pain. This usually means stopping any running or jumping. Anti-inflammatory medications such as aspirin or ibuprofen are very useful. After resting the knee until the pain and swelling go down, reconditioning may be needed to regain full range of motion, strength etc and cross training will be of benefit. Other nonsurgical treatments involve taping the kneecap or using a special brace for knee support during sports participation. Sports Massage with the aid of anti-inflammatory gel is affective. Clients should also try a foam roller that is often recommended. This also can be an effective home treatment. Foam rollers do have mixed opinions from professionals but I have personally found them to help. Cortisone injections administered by GPs are also effective for many.
Use of the RICE formula is also applicable:
Some athletes temporarily switch to a non-weight-bearing activity, such as swimming.
Apply cold packs for short periods of time, several times a day.
Use an elastic bandage such as a simple knee brace.
Keep the knee raised up higher than the heart.
When needed, surgical treatments include:
The surgeon removes fragments of damaged kneecap cartilage through a small incision, using a pencil-sized instrument called an arthroscope.
The surgeon opens the knee structure and realigns the kneecap, reducing the abnormal pressure on cartilage
Runners knee is a fairly common condition that is painful and can also be painful to treat. If you have any symptoms make sure you get them checked early as this is not an easy to treat, as often it is the fascia that we are working on at the side of the thigh. But sports massage treatments, self stretching and foam rollers can have very good results.
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