Runner’s Knee: Know it to keep running!

The marathon season is upon us. No doubt running is the most accessible and hence the most popular form of exercise. It strengthens the cardiovascular system, builds endurance and freshens the mind.

Although it is a great exercise for the knee joints as well, quite a few runners feel persistent knee pain associated with the activity. One of the most common causes being ‘Runner’s Knee’, also known as Patellofemoral Pain Syndrome (PFPS) in medical terms.

If you are a runner or someone who experiences pain over the front of the knee, understanding its causes, symptoms and treatment options is the key to a safe return to an active lifestyle.

So, what exactly is ‘Runner’s Knee’?

It is a broad term used to describe pain around the front of the knee and behind the kneecap (patella).

The patella normally glides smoothly within a groove at the lower end of the thigh bone (femur) during movements. When this movement becomes abnormal due to muscle imbalance, overuse or disturbed joint biomechanics, it causes friction at the patellofemoral joint.

This leads to inflammation, swelling and pain, especially during activities like running, climbing stairs, squatting or sitting for prolonged periods with bent knees.

Despite the name, this condition doesn’t only affect runners; it’s also common in cyclists, hikers, and individuals who spend long hours on their feet.

Why does it happen?

Multiple factors contribute to the development of Runner’s Knee. The key underlying mechanism is improper tracking of the patella in its groove. Common causes include:

1. Repetitive Stress: Continuous running or jumping without adequate rest can strain the knee joint, leading to cartilage wear and soft tissue inflammation.

2. Muscle Imbalance: Weak quadriceps, hip abductors, and gluteal muscles can lead to improper patellar tracking. Tight hamstrings, iliotibial band (ITB) tension can worsen the imbalance.

3. Foot Abnormalities: Flat feet, overpronation or high arches can alter knee joint mechanics and increase stress on the patellofemoral joint.

4. Improper Training Techniques: Sudden increases in mileage, running on uneven surfaces, or poor footwear choices often contribute to knee strain.

5. Previous Injuries: Old ligament or cartilage injuries can alter knee alignment and make an individual more susceptible to PFPS.

6. Structural Factors: Anatomical variations like increased Q-angle (especially in females), patellar tilt, and shallow trochlear groove can predispose individuals to patellofemoral instability.

   
   

How to know if you are suffering from ‘Runner’s Knee’?

The hallmark symptom is pain around or behind the kneecap. The discomfort often develops gradually and may worsen with activity. Common symptoms include:

• Dull aching pain over the front of the knee

• Pain during running, jumping, squatting or stair climbing

• Knee stiffness is

  gradually building up after sitting for a long time - ‘movie theatre sign’

• A grinding or popping sensation when bending the knee

• Swelling around the kneecap in more severe cases

If left untreated, chronic inflammation can lead to cartilage softening (chondromalacia patellae), further increasing the pain and limiting the activity.

Confirming the diagnosis

It is essentially a clinical diagnosis made by an orthopaedic surgeon. Assessment includes:

• Physical Examination: Evaluating knee alignment, patellar tracking, foot anatomy, muscle strength and flexibility.

• Gait and Posture Analysis: To assess running mechanics or walking patterns.

• Radiology:

  • X-rays: rule out bony malalignment, early arthritis

  • MRI: needed if a cartilage injury or a soft-tissue pathology is suspected

This comprehensive approach ensures a thorough understanding of the root cause of the pain, allowing to form a customised treatment plan.

Is it treatable? How?

Most cases can be managed conservatively focusing on reducing the symptoms, correcting the biomechanics and restoring normal knee function. Treatment needs to be customised as per the root cause.

1. Rest and Activity Modification:

The first step is to cut down on activities that worsen pain, such as squatting, stair climbing, sitting on the floor, and lunges. No-impact exercises such as swimming or cycling can be continued.

2. Anti-inflammatory Measures

Applying ice packs and using anti-inflammatory medications can reduce pain and swelling in the early acute phase.

3. Physical therapy

Rehabilitation is the cornerstone of Runner’s Knee management. A tailored physiotherapy program should focus on:

• Quadriceps strengthening (especially the VMO)

• Hip and core muscle activation

• Stretching of tight structures such as hamstrings, calves and IT band

• Balance and proprioception training for better joint control

• Posture & gait training

4. Footwear and Orthotics

Using good supportive running shoes or custom orthotics for foot abnormalities can correct the foot malalignment and reduce knee stress in the long run.

5. Patellar Taping, Bracing

Kinesio taping, patellar tracking braces can help stabilise the kneecap and reduce pain during activity.

6. Platelet Rich Plasma (PRP) Injection

In cases with early cartilage wear behind the kneecap on MRI and not responding to routine treatment options, platelet-rich plasma (PRP) injection is an option to promote healing and improve cartilage health.

7. Surgical Intervention

Surgery is quite rarely required but may be indicated if conservative measures fail to relieve the symptoms.

Procedures depend on the underlying cause and may include lateral patellar retinacular release, realignment of the patella, or arthroscopic cartilage debridement to name a few.


What is the rehabilitation timeline?

Recovery from Runner’s Knee requires patience and consistent rehabilitation. Depending on the severity and duration of symptoms, most athletes can return to pain-free running within 6 to 12 weeks.

Can it be prevented altogether?

Yes! Prevention is always better than cure. Adopting a few key strategies can significantly reduce the risk:

1. Strengthen the core and hip muscles

2. Warm up and stretch religiously before and after every run.

   

3. Gradually increase mileage and intensity to avoid overuse injuries.

4. Wear proper running shoes suited to your foot type and replace them regularly.

5. Cross-train to build endurance without repetitive knee stress.

6. Listen to your body! Rest when you feel discomfort rather than pushing through pain.

7. Regular musculoskeletal assessments at a sports clinic can also help detect early signs of overload and prevent chronic injuries.

When should you visit an Orthopaedic Surgeon?

If knee pain persists despite rest, home remedies and if it interferes with your daily activities, consulting a specialist is essential.

At ArthroSports Clinic, Dr. Ajinkya Achalare offers comprehensive evaluation and evidence-based management tailored for athletes and fitness enthusiasts. His approach combines clinical acumen, advanced diagnostic imaging, targeted physiotherapy and modern arthroscopic techniques (if need be) to ensure the best outcomes.

To conclude..

Runner’s Knee may sound harmless, but it can significantly disrupt your active lifestyle if neglected. Understanding the biomechanics of the knee, addressing muscle imbalances, and following proper training principles are key to both treatment and prevention.

With early diagnosis and a structured rehabilitation plan, full recovery is achievable, allowing you to get back to running stronger and safer!

Happy running!

If you’re struggling with knee pain while running or during workouts, visit ArthroSports Clinic at Shivaji Park, Dadar West, Mumbai, for expert care. Under the guidance of Dr. Ajinkya Achalare, regain your strength, mobility, and confidence to return to the activities you love!

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