What is Runner’s Knee?

According to the Patellofemoral pain consensus statement, given at the 4th International Patellofemoral Pain Research Retreat, PFPS can be defined as ‘Pain around or behind the patella, which is aggravated by activity that loads the patellofemoral joint during weight bearing on a flexed knee (as in running) and could included but not necessarily, crepitus, tenderness to palpation, effusion, and pain upon rising or straightening the leg after sitting.

While this sounds very general and vague, it does help us eliminate some of the other common running knee injuries, as most have their specific criteria for diagnosis.  Simply put, Patellofemoral Pain Syndrome is a pain over, under, or around the kneecap that is aggravated by running.

Common Causes of Patellofemoral Pain Syndrome - Runner’s Knee

As we study patellofemoral pain syndrome, we understand that load compounds and becomes too much. This excess stress can wear away the protective layers around the joint, causing pain during common movements. As runners, we can understand that on each and every step, we are loading the knee joint, thousands of times every run. 

While running, we load the knee with 4-6 times our body weight with every step.

Hopefully, something just clicked, and you now realize why you need a day off every week…sometimes two, to allow for proper recovery and regeneration of your tissues. As runners, we can not continue to pound the pavement and climb the trails, day after day, and expect our bodies to cooperate. Below are common issues and training errors that lead to Runner’s Knee pain.

• Terrible Too’s: Too Much, Too Fast, Too Hard, Too Soon. A rapid increase in volume and intensity spells disaster for runners.

• Tight or Weak Supporting Musculature: Hip, hamstrings, and calf complex weakness is a common issue among runners and must be addressed with a structured rehab and strength training plan.

• Poor Warm-Up & Mobility: Many runners skip their warm-up and maybe stretch every other day. This needs to change.

• Lack Of Training Variety: The same shoes, distance, speed, and terrain. Try performing intervals, running on the trails, and alternating long and short runs. Variety helps!

• Poor Strength Capacity: Runners need to be strong! Your body is not currently strong enough to handle the stress of running at the volume and intensity you are trying to perform. Strength training is a must for runners.

How Do We Treat Patellofemoral Pain Syndrome - Runner’s Knee?

When to seek care while dealing with patellofemoral pain is a common question we encounter.  In all honesty, our natural tendency is to ‘wait & see’ and try to wait out or run the problem away. Furthermore, some will try and rest a week or two, putting training on hold, only to start running again and find the knee pain is still present.  

Not to be all high and mighty, but in my professional opinion, the earlier you seek care, the less likely you are to lose precious training time, and the quicker we can get you over Runner’s Knee…not just my opinion, the research demonstrates this.  To help simplify this, here are three rules to adhere to when debating care for your knee pain.

Knee pain is worsening with each run, earlier in the run, and lasting longer after each run causing your training to suffering.

Knee pain is not responding with consistent self-care and proper warm-up and cool-down routines.

Knee pain starts to be present during regular daily activities such as walking, taking the stairs, and rising from a chair.

What Treatment for Patellofemoral Pain Syndrome - Runner’s Knee Looks Like

Once you have decided to seek care, below is what you can expect from a sports chiropractic office like ours.

ASSESSMENT: The first and most important step in treatment is a thorough evaluation and history. We must have an accurate diagnosis to formulate the best treatment plan for you and your goals. This also includes our 3-tiered running-specific evaluation that helps us guide you back to unrestricted, pain-free running.

IN-OFFICE CARE: Our in-office care is made of 3 phases:

(1) Soft Tissue Care: This may include IASTM, Myofascial Work, Assisted Stretching, and Dry Needling. We aim to decrease muscle tension, sensitivity, and pain.

(2) Proper Joint Mobility & Movement Patterns: Joint manipulation is essential for proper movement through the running gait cycle. Restrictions in the foot, ankle, or hip can lead to compensation patterns and potential problems in the future.

(3) Corrective Exercise: Soft tissue work and joint manipulation will only have a temporary effect if they are not followed by corrective exercise. We aim to ‘reprogram’ your movements and build strength to handle the stress of running.

HOME CARE: Home care will include regular mobility work on your problem areas, effective warm-up strategies to further progress your running, and strength exercises to continue rehab outside the office.

RETURN TO RUNNING: We want to maintain some running while you progress through care. This may require a sharp decrease in volume and intensity at first but will stair-step back to your normal running as care progresses.

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