In lockdown I’m probably seeing more people out running than ever before which has encouraged me to dust off my running shoes and hit the tarmac. Some of you may find that your new running habit is giving you painful knees, something known as ‘Runner’s Knee’.
If so, read on . . .
What is Runners Knee?
Runner’s Knee is the most common injury amongst runners, in more medical circles it is known as patellofemoral pain syndrome. I think I will stick to the term Runner’s Knee for now! The pain will normally be felt as a deep, diffuse pain which you may notice while you are running, but you may also notice it when you are going up or down stairs. The pain is caused by an irritation of the tissue behind the knee cap which is due to inflammation.
So What Brings It On?
Runner’s Knee can develop if you are not used to the level or running you are doing. The inflammation can be brought on if you are regularly pushing yourself to run beyond the level at which your body is capable. It doesn’t mean that you can’t run longer, faster or more frequently – but you need to build up to it slowly so your body tissues can acclimatise to the increased activity and load.
Even if you are a seasoned runner, it may develop if you alter your running gate, your distance or the terrain that you run over; longer runs, more inclines, faster runs or even through switching things up a lot by running fast one day, and long another.
So Do You Have To Stop Running?
No. Interestingly the evidence suggests that you should actually increase the frequency of your training but you should aim to reduce the impact of your runs by running shorter distances and running over flat terrain.
A key objective for runners is to get out of pain as quickly as possible and often this can be assisted by taping the knee or wearing knee supports. This maybe enough for some runners if it allows the inflammation to settle down by minimising the impact on the knee joint.
So What Does the Research Say?
A recent study looked at 3 different approaches to management of Runner’s Knee.
Education and training modification
An exercise programme plus Education
Gait retraining plus education
The FIRST group was educated about the cause of the pain and the importance of reducing stress on the knee joint by of running well within their limits. They were instructed to increase training frequency but reduce the duration of their runs and cut out any hill work. Each run should result in minimal pain (pain score of 2/10 or less) and any pain should down to the pre-run level within an hour of the run. They were also advised that there should be no increase in symptoms the following day or they were to reduce their run further.
The SECOND group were given a specific exercise programme which gave them 20 minutes of exercises to do 3 times a week. The exercises focused on strength and dynamic control and consisted of:
Side-lying Abduction of the Hip to strengthen the glutes – holding the top leg at 30 degrees and holding it there for 40 seconds, relax, repeat five times.
The Plank
Single Leg Bridge – lying on your back with bent knees, raise your hips off the ground and then extend one leg.
The THIRD group looked at gait retraining. Runners were advised to increase their cadence by between 7-10% (which means shortening their stride length by 7-10%). This has the effect of switching their impact to more of a forefoot strike although in theory this also puts more strain on the calf.
So Which Approach Was Best?
None of them. No one group showed better results than another group.
And all of them. Statistically all of the groups showed significant improvement.
So What Does That Mean??
This is good news for me. Each of these approaches could be useful in some cases, but not in all cases.
Ideally I would want to see someone run in order to determine which approach was best for them. In a trial like this, participants are allocated to each group at random, so in each group there would have been a proportion of participants in the appropriate group, but a proportion of them would have been better in a different group.
I would recommend different approaches for different people I am not just treating the injury, I am more interested in what has brought it on and how best to resolve it on a case by case basis.
So What Is My Advice
Without seeing you run it is difficult to recommend you one approach over another but just knowing the cause of the pain and understanding the intention of treatment may be helpful. The strength exercises will be helpful as they will help you to avoid injuries and strain on your knee joint.
Prevention is better than cure, so structure your training program so that you only increase distance and difficulty of your runs very slowly. If you notice any knee pain, drop the intensity of your run but keep training regularly.
If you book in for a running assessment I can assess your pace and running style to see what exercises may be beneficial to you. Improving your running gait can have a significantly positive impact on your running time, and help to decrease your risk of running injury.
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I am always reading and researching to make sure I base my clinical advice on the best possible foundations. Covid19 has given me a bit of extra time, so I am going to write short pieces on some of the thought provoking research that I read.
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Thank you, and stay safe,
Nick