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  • Steve H. Yoon, M.D.

Understanding Runner’s Knee

By: Steve H. Yoon, M.D.

Whether we know it or not and whether we are runners or not, we have most likely experienced some form of “runner’s knee” at some point. First and foremost, the term "runner's knee” can be a little misleading. While it refers to any condition that causes pain around the kneecap, the biggest misconception is that it is a condition that only afflicts runners. Just as "tennis elbow" doesn't necessarily happen only to tennis players, "runner's knee" is a condition that any activity type can impart repeated stress on the knee joint can cause patellar pain – whether that activity is walking, cycling, skiing, playing soccer or running.

Runner's knee is also called patellofemoral pain syndrome. It refers to pain that is generated underneath or around the kneecap. No matter the activity that causes it, runner's knee usually occurs due to an abnormality in the movement or tracking of the kneecap over the thigh bone (also called the femur bone) with activities such as walking, kneeling, or running. The knee abnormality may result from improper body mechanics, misalignment of the kneecap, weak or inflexible thigh muscles, flat feet, overuse, trauma, arthritis, or a fracture or dislocation.

From a risk perspective, runner's knee tends to occur more often in women than men, especially during middle age. Additionally, being overweight or obese may increase the risk of problems with knee pain conditions.

The most telltale sign of runner's knee is a dull ache surrounding or behind the kneecap. The pain may be especially prevalent near where the kneecap meets the lower part of the thighbone. The pain is most often present during activity but may also present when sitting for an extended period with the knee in a bent position. Other symptoms of runner's knee include swelling at the kneecap or popping or grinding sound upon knee flexion.

Initially, relieving the pain associated with runner's knee can be accomplished by discontinuing the activity causing the pain. I know this sounds like a simple recommendation, but you might be surprised at how many people continue to push through knee pain, only to prolong or make it worse. If you experience pain doing a particular exercise activity, switch to another activity that doesn't cause pain, or take some time off to rest and heal. In addition to rest, ice and over-the-counter anti-inflammatory topical and oral medications can help reduce the pain and swelling from runner's knee. Soft tissue massage around the kneecap and leg may also help.

Suppose the pain does not subside with traditional rest and self-administered over-the-counter treatments. In that case, you'll likely need to see your doctor or physical therapist to confirm a diagnosis and begin a treatment plan. Further testing

may include diagnostic imaging such as x-rays and a biomechanics evaluation to help establish a proper care plan. Under the care and guidance of a medical expert, mechanically retraining the body to use the hip, gluteal, and hamstring muscles with activity, instead of only the knee, will help transfer the mechanical forces off the kneecap which will ultimately help with the pain. The results of this type of rehabilitation may take 3-4 months to see results. I know that can sound like a long time, especially to highly active people, but the result can be worth it.

Though runner's knee is a painful nuisance for many, it doesn't have to be. There are plenty of things people can do to help prevent knee problems from sidelining them. As mentioned, dedicated strength training focusing on the hip, gluteal, and hamstring muscles is crucial. When these muscles are strong and flexible, they help immensely in transferring the burden off the knees. In addition to strength training, stretches to increase knee flexibility and prevent irritation are also highly beneficial.

Finally, since we are talking about "runner's knee" after all, be sure that the running shoes you're wearing are in good shape. Quality and adequately fitting running footwear with good shock absorption is what you're looking for. Don't forget to check your form when running too. A tight core helps prevent the body from leaning too far forward or backward and, whenever possible, run on surfaces that are flat and smooth. Doing what you can to avoid developing knee pain is your best bet for staying healthy and continuing the activities you love.


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Wonder if the squeaks, creaks, pops, or snaps they hear coming from their knees are a cause for concern or a signal for medical attention.

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