Overcoming Runner’s Knee
What is Runner’s Knee and why does it happen?
Runner’s knee and patellofemoral pain syndrome are simply the medical terms used when you are experiencing pain and sensitivity at the knee. While pain is certainly complex, there tends to be a common trend leading up to the presentation of these symptoms. Runner’s knee (and many other injuries at other joints) can occur when the demand placed on the knee exceeds its current capacity. In other words, the stress placed on the knee is greater than the knee's current ability to handle that stress. An example of an increased demand/stress can be due to your mechanics (sometimes a change in shoes), increased mileage, increased speed/intensity, etc. It's also important to note that you have control over the capacity of your knee. It can be improved through strategic running prescription, strength training, and optimizing your recovery (nutrition, sleep, hydration, stress management, etc).
What can you do about it?
The two most important pieces of overcoming runner’s knee in runners is:
Finding a way to manage the pain to continue running or return to running.
Finding a way to ensure you reduce your risk of this happening again.
Management strategies to continue or return to running:
Again, pain is complex and often isn’t that simple. But, there are trends observed in manipulating different factors to help temporarily reduce the stress experienced at the knee. Some or all of these strategies may not work for you- it’s important to try one at a time to identify what is working and what isn’t. If none of these work for you, it does not mean you are a lost cause, it just means you need a different strategy.
Avoid running downhill. Walk down hills if you need to.
Try continuous running. It’s often recommended to utilize run:walk intervals when returning to running. For some knee pain, the starting and stopping is actually not helpful.
Try to run just slightly faster. This one is tricky. Again, many injuries feel ‘better’ with slower running. But, knee pain can sometimes benefit from a quicker step rate.
Increase cadence. An increase in cadence can help to reduce the ground reaction forces experienced at the knee.
Try the treadmill. The treadmill can be helpful with reducing the stress placed on the knee.
Try a slight incline. If you have no trails or paths with a low grade incline near you, the treadmill can be very helpful to achieve this.
Try a low drop shoe. Low drop shoes are helpful with decreasing the stress experienced at the hip and knee. It’s important to keep in mind that they increase the stress placed on the foot and calf. High drop shoes have the opposite effect.
Decrease your training volume. Like many of these other strategies, this is just a temporary change. But, it can be a way to recover from accumulated stress and add more rest without fully stopping.
Reduce your risk of recurrence and build resilience in the knee:
Every strategy above is helpful at reducing stress on the knee. What that means is that doing the opposite of any of those strategies is a way to build resilience in the knee. Again, don’t do it all at once if you aren’t ready for it. Try one at a time when you are ready to expose.
Strength training is another very important strategy for runners to utilize. Strength training is known to improve economy and performance in runners by 2-8%. There are plenty of knee specific strength exercises that can be utilized. Remember, everyone’s knees have a certain capacity (that can be improved). But, we don’t want to do too much too soon and end up with an angry knee again. Start slow and build from there. Here are just a few of our favorite exercises that can be helpful for building strength in the knee:
Heel elevated squats
Step ups
Walking lunges
Assisted sissy squats
Single leg drop squats
Lateral bounding
So, how do you know if you need to stop running?
When it is safe to do so, it is advantageous to continue running. (See our blog on this topic here) But, a definite answer to this question cannot be determined without a thorough professional assessment. If no strategy is helping to improve your pain or if your pain is worsening, it might be time to seek professional guidance. If you need clarity, we are happy to help. We offer in person appointments in Wayne, PA and virtually worldwide. You can inquire about our services here.
References:
Effects of Strength Training on the Physiological Determinants of Middle- and Long-Distance Running Performance: A Systematic Review. 2017.
Effects of Strength Training on Running Economy in Highly Trained Runners: A Systematic Review With Meta-Analysis of Controlled Trials. 2016.
