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Runners Knee

'Runners knee' is a common term used to describe a group of conditions causing pain around the patella (knee cap) and are issues which are prevalent in runners. The conditions under the umbrella term 'runners knee' include:

- Iliotibial band syndrome (ITB syndrome)

- Chrondromalacia patella

- Patellofemoral maltracking

- Anterior knee pain

Despite it being termed runners knee, it is in fact very common to experience runners knee with other sports and activities, such as cycling, jumping and walking.

What are the symptoms?

The classic symptom of runners knee is a dull aching pain behind or around the patella. In the instance of ITB syndrome, pain is typically more on the outside of the knee.

It is usually pain free at rest, but painful with activities such as squatting, kneeling, ascending or descending stairs, running, moving from a sitting to a standing position, walking or sitting with the knee flexed (bent) for a prolonged period.

You may experience some grinding or clicking around the patella and there may even be some swelling.

What causes runners knee?

The symptoms described above occur due to irritation to soft tissue structures around the patella. This includes the patellofemoral ligaments, bursae (fluid filled sacs) which provide cushioning and shock absorbance in the knee joint, or the patellofemoral joint surfaces; either the underside of the patella itself or the joint surface (trochlea groove) formed by the femur (thigh bone).

The following can be contributing factors to the development of runners knee:

- Significant change in training load

- Significant change in activity which may lead to increased compression of the patellofemoral joint i.e. prolonged sitting

- Trauma to the patella i.e. direct blow from a fall

- Repetitive kneeling

- Patella malalignment due to an imbalance between the soft tissues around the patella or as a result of a structural issue, for example a shallow trochlea groove

- Foot pronation when walking and running

- Weakness or tightness in the quadriceps muscles, ITB or gluts

How is it diagnosed?

A physiotherapist can usually diagnose runners knee without the need for further imaging such as an x-ray or scan. The physiotherapist takes a full subjective history of the symptoms, lifestyle factors which may contribute and a full medical history. We then perform an objective assessment, which might include testing the knees range of motion and the power of the muscles surrounding the knee. There is usually some tenderness to feel around the knee and compressing the patellofemoral joint can reproduce the symptoms. A gait analysis of your walking and/or running can also provide useful information to further tailor your treatment.

How is runners knee treated?

Broadly speaking, runners knee can be treated conservatively in the majority of cases with physiotherapy. It is essential that the contributing factors are identified so that these can be addressed, such as any muscle imbalances around the knee to inform a strength and conditioning programme, if there are any other biomechanical issues which need to be addressed such as orthotics for pronated feet. It may also be necessary to adjust training load to allow time for the knee to recover. Using anti-inflammatories, ice and some knee supports or taping can also be useful for symptomatic relief.

Do you think you might have runners knee?

If you can relate to these symptoms described and believe you may be experiencing runners knee, and it is not responding to rest, ice and anti-inflammatories, you are likely to benefit from physiotherapy.

If you'd like to find out more, get in touch today.

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