Patellofemoral pain syndrome (Runner’s knee):  This is probably the most common problem we see in runners.  There are 10,000 reasons you can have runner’s knee.  Anything from incorrect shoes to too many miles too soon, to a leg length discrepancy to, ….. you name it.

History: You cannot recall any specific injury.  You have pain behind the kneecap when running, ascending or descending stairs (especially worse if you go up or down right after a run).  It is pretty common to have increased pain with driving or prolonged sitting.  In the beginning you only have pain with running or immediately after running.  The longer the problem persists, the longer after your run the pain continues.  You can have increased pain with increased activity intensity or time. 

Self-Exam:  Here are some things you can look for in yourself. 

1)      Stand in front of a mirror and look at the muscles just above your kneecap.  There may be decreased mass of the muscles. PH 

2)      Stand at the top of a stair.  Slowly step down with your sore knee.  Then repeat the process with your sore knee at the top of the stair. VID If your knee hurts like begebbers or almost gives away, this is a pretty good hint you have runner’s knee. 

3)      Stand in front of a tall mirror and complete a mini squat.  VID  If your sore knee collapses inward when your knee hurts, this is another good test for runner’s knee.  However, you probably have a lot of other things going on than just runner’s knee and you probably need to come and see us for a personal evaluation.  This is especially true for female runners.

Treatment:

1)      Manage the pain:

a.      NSAIDS will help.  Kinesiology taping to stabilize your knee until you get your strength back.  LIN Over-the-counter knee sleeves with a patellar cut-out may help.

                                                              i.      More expensive is not necessarily better.   Knee sleeves are pretty generic and fit a general group of sizes.  Taping may take more time to apply, but it will fit YOUR knee versus a generic knee.

b.      Continue running but avoid aggressive speed work and hill repeats, especially downhill running.

2)      Restore full motion:

a.      A lot of patients with runner’s knee have tight hamstrings and/or quads.  Make sure you include stretching all your muscles as part of your training program.

                                                              i.      Stretching does not have to be part of your warm-up or cool-down.  But it HAS to be part of your training program. LIN

3)      Begin non-weightbearing exercises to restore strength without all the pressure on the joints

a.      Most exercises involve minimal movement of the knee joint to reduce pressure on the joint as it recovers

b.      My favorite is KISS.  Keep it simple Sam (Or Samantha)

                                                              i.      The basic knee exercise is the static quad setting with your knee fully extended.  About 10,000 per day.  Okay, not that many, but you get the idea. LIN  LOTS

                                                            ii.      Other great exercises you can do at home are: Straight leg raise, Short arc quad and, Static hamstring sets

c.       You will not be at this level very long; we just need to increase your strength while minimizing stress on your knee.

4)      Begin body weight exercises with emphasis on control versus strength and power.

a.      Apply the kinesiology tape to your knee before you start your weight-bearing exercises.

b.      These are done slowly, with a short range of motion, and STOP BEFORE IT HURTS.

c.       Wall-slides, sit-to-stand, static lunges, lateral step-ups, etc.  LIN

d.      If you can, complete these in front of a mirror so you can watch your knee stay in track above your foot.

e.      As soon as you can step down from the stair without pain or complete a deep squat without pain, you can progress to your regular strength training and running programs.

f.        Continue to tape your knee before your hard workouts

5)      Correct running mechanics.

a.      Gradually return to your previous running.  Start on relatively flat ground or even on a treadmill.  The best part of returning to running with a treadmill is that you can actually hear your footsteps.  Also, a lot of treadmills are in front of a mirror so you can see your hands move and your feet move.  If your arms or legs swing weird, you may want to have a physical therapist complete an evaluation before you return to full running.  Listen and ‘feel’ how you run.  Is one leg hitting the ground harder than the other?  Does one arm swing differently than the other?  Until you can run without pain and with fairly symmetrical running mechanics, you are still at risk of reproducing your old injury or creating a whole new injury to another part of your body.

b.      As soon as you can run without pain and without a limp you can return to your normal running routine.

6)      Return to running speedwork and hills.  After you have been able to run on flat ground for a week with your with your normal training and have not had any pain, you can begin to add speed and hill training to your program.

7)      My favorite step, get back to full running!  Have fun.  Eventually you will bust something else and be back to the website to fix that. 

8)      If you follow the steps on the website for 2-6 weeks (depending on how badly you hurt yourself the first time and on how long you tried to ‘run through the pain’) and your problem does not resolve, then call our clinic for an appointment and we can do something Dr. Google cannot do.  We can complete a hands-on evaluation, in-person evaluation to determine the cause of your pain.