Often Missed Causes of Runner's Knee and How to Fix them, Naturally
If you’ve run for any amount of time, you may have felt a twinge in your knee. Sometimes it is from a wrong step or an unexpected obstacle while other times it is something that builds over time. While often felt during running, this type of knee pain isn’t limited to runners.
Whether you’ve been diagnosed with runner’s knee or not, people with this often feel knee pain going down stairs or have knee pain in lunges or squats. This pain can be felt either as a dull ache all the way up to a sharp pain anywhere around or underneath the kneecap.
Runner’s knee is sometimes known as Patellofemoral pain syndrome or PFPS and is one of the most common knee pains in runners. Some of the questions I often get asked are
“How long does runner’s knee last” or
“Can I still run with Runner’s knee” and
“How do you fix runner’s knee”.
In this post, I’ll cover 3 of the most common things I recommend to start fixing runner’s knee.
What causes runner’s knee?
Before we dive into what causes it, we need to understand a bit about the part of the joint we’re talking about. Our knees are divided up into 2 joints with a third joint very close by. The main knee joint is between the thigh bone and the shin bone. This is where our meniscus, our ACL, and other ligaments are.
When talking about runner’s knee, we’re talking about the joint between the kneecap or patella and the femur or thigh bone. The kneecap slides up and down in a groove at the bottom of your thigh bone. It slides up when you straighten your knee and down when you bend your knee. It also has some wiggle room on either side of it.
When there is too much wiggle room i.e. the joint is too loose, or when there are kneecap tracking problems, that is usually what causes patellofemoral pain syndrome.
So, what causes those tracking problems? We find that many of the people who come to Body Mechanix Physiotherapy for runner’s knee treatment have a combination of things going on. First the kneecap is “stuck” too far to the side(usually towards the outside) and is pushing up against the groove in the femur often causing a pinching feeling on the outside of the knee while also causing a dull ache on the inside of the knee.
What are runner’s knee symptoms?
Runner’s knee will sometimes cause swelling below the kneecap as the bursa becomes irritated. This sometimes results also in knee bursitis as well. As a result, sometimes it will feel like a knife is stuck into the top or underneath the kneecap. Sometimes it is felt as a pinching on the outside of the kneecap while the inside is very achy and tender to touch.
What Causes Runner’s Knee
Generally, runner’s knee happens when our supporting muscles either aren’t strong enough to control our knees during running or our stride is such that there is too much side-to-side movement at the knee joint when the foot strikes the ground. Usually we find that there is some weakness to the hip muscles that control the knee, mainly the glutes. This causes the knees to go towards each other or bow in when going up and down stairs and sometimes causes your running gait to scissor or have your heel whip out when pushing off in your running stride.
While the hip is a main cause of Runner’s knee, we also find that sometimes runner’s knee is an issue either in the spine or ankle that forces the knee to take more of the load when running, walking, or when lunging or squatting.
How long does it take to treat runner’s knee?
When treated properly, this kind of injury usually lasts no longer than 4-6 weeks. For many, we don’t need to stop running but we might need to change the volume(how many miles), the surface(trail vs. pavement), or work more intervals into your training while taking care of the root causes of it.
Unfortunately, rest usually does not fix runner's knee and can even make it last longer than it should. When we only rest an injury, we often are able to get it to calm down at rest but do not fix the underlying causes of this kind of knee pain. If you’ve only rested then often the knee pain comes back once you try running again.
Should I stop running with runner’s knee?
This is a good question and unfortunately, it depends on how severe your condition is and how much your running stride or gait is contributing to your symptoms. If your knee bothers you from the start of your run and gets worse as you run, then a short lay-off now and focusing on finding the source of your knee pain and then directed treatment will mean a faster recovery and return to running later(often at a faster pace and over more miles). If your knee pain starts later on in your run, then potentially changing your surface that you are running on(i.e. Street vs. trail or track) might let you keep your miles while fixing the overall problem. (Request a free running injury consult with one of our Doctors of Physiotherapy to get to the root of your knee pain)
3 Keys to Fixing Runner’s Knee
Key Number 1: Find the cause of why your knee is hurting. If your knee bowed in towards the other knee or tracked inside of your big toe, then your knee pain is most likely coming from your hip. This can be either from the hip muscles not being strong enough to control how the thigh is moving allowing it to bow in and twist at the same time which causes your kneecap to run up against the outside of your knee and cause pain. This hip weakness can be caused by issues coming up from the foot(especially if you are dealing with pain in your arch or bottom of your foot) or when dealing with back pain which then limits your hip strength. For many, fixing their hip strength then lets their kneecap glide more centrally and comfortably.
Key Number 2: Making sure your running stride is not contributing to your knee pain.
When you are running, do your feet scissor across each other in front of you or are they so narrow that they look like they are running in-line with each other(think running on a balance beam)? This kind of gait causes your knees to bow in while placing extra stress on the outside of your hips and into the arches of your feet. Next, does your foot whip out when you push off? (if you don’t know-have somebody film you as you run by filming from the front and back. If your knee pain starts after a few miles, have them film you at the start then when the pain starts. See what changes happened to your running stride.(need help analyzing your running video? Our Doctors of Physiotherapy will be happy to look over it with you during our complimentary running injury consult).
Key Number 3: Don’t miss training time by waiting to see if 6 weeks of rest(what most physicians prescribe), icing, and pain meds “fix the problem”. I understand that the RICE method gets some people back to training but for most injuries, this merely calms down the symptoms at rest and rarely fixes the underlying causes of the problem. Runner’s knee treatment when started early on often allows you to continue training while preparing for your next road race, triathlon, or obstacle course race(my favorite-I’ve done multiple Tough Mudders and Savage Races and planning on more). Runner’s knee treatment often centers around finding and treating the source of the problem while at the same time working on the pain in the knee. Next we progress to fixing your foundation(i.e. The thing that started it all whether that is stiffness or weakness) and finally building your performance strength, endurance, and speed so you can make your next PR or just finish your first 5k.
If this article describes your story and you are looking for some help with something like knee, back or neck pain, we offer FREE consultations, which give you the opportunity to come in and meet us and see for yourself how we can help you.
Here are just a few of the things you will learn in one of our free consultation:
What is the underlying cause of your pain? (hopefully nothing too serious!)
Roughly, how long will it take to fix the problem?
What to do to help – which doesn’t include painkillers, resting or surgery etc.
What other, natural, drug free methods are there to speed up recovery alongside treatment?
Our consultations are great for anyone that may be “unsure” if physio is right for them, and they give you the opportunity to ask questions and see for yourself if we can help you.
If you’d like one of our limited free consultation sessions, please click here to request your Total Body Diagnostic or CALL us on 850-765-2779 to make a no-obligation enquiry.
About the author
Brandon Alkire, DPT, CSCS, FMS, Cert. DN
Doctor of Physical Therapy and Strength Coach
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