Overuse Injuries in Runners: Anterior Knee Pain

Knee Pain in Runners: Causes and Management

PFPS: Common Causes

Two common causes of anterior knee pain are patellofemoral pain syndrome, which we will focus on in this article, and patellar tendinitis which we will cover in a future post. Patellofemoral pain syndrome (PFPS) is an irritation of the joint between the patella and the femur (thigh bone). One of the common causes is faulty biomechanics in the lower extremity which increases the stress and strain at the knee. The stress occurs between the undersurface of the patella, and the groove on the end of the femur, in which the patella glides.

The function of the knee is affected by the foot and the hip.  A common contributor to PFPS is strength deficits in the hips, specifically, the gluteus medius and gluteus maximus which provide stability to the hip and pelvis. Weakness or instability here will be magnified through the length of the femur to the knee and cause increased sheer and strain on the patella which will eventually result in an inflammatory response. Over the course of a run, this stress and strain is exerted on the knee several thousand times and can become a nagging, if not debilitating, problem. Fortunately, there are management strategies if you are experiencing this pain with running, and preventative strategies to help keep you running pain free.

Management of Knee Pain

Management of anterior knee pain with running typically will focus on a bottom-up and a top-down approach. The bottom-up approach starts by making sure that proper footwear is being worn based on foot type. This post will focus on the top down approach which addresses hip and core strength deficits and instability.

The Top-Down Approach

In running, there is heavy use of the thigh muscles – quadriceps – and calf muscles – gastrocnemius and soleus – because of the forward propulsion. Unfortunately, there is not a lot of demand on the lateral stabilizers of the hips with running, and so if not specifically addressed in a strength training program, these muscles will not be able to adequately stabilize the pelvis and lower limb with distance running. If running is your thing, you should also be incorporating a good flexibility and strength training routine into your plan. Here are some key stretches to include:

• Quadriceps stretch
• Hamstring stretch
• Calf stretch
• Glutes/Piriformis stretch
• Foam rolling IT bands and quadriceps
• Hip flexor stretch

A strength training program for hips and core will also be a key component in your training regimen. Some good hip and core exercises are:

• Bridges
• Bridges with leg lift
• Clam shells with progressive resistance
• Quadruped Fire Hydrant with progressive resistance
• Standing Fire Hydrants with progressive resistance
• Prone plank progression
• Side plank progressions

Whether knee pain limits your ability to run or it’s just a mild nuisance, it is your body trying to tell you that something isn’t quite right. If managed early enough, you may not even need to reduce your training mileage. But if you are trying to run through the pain, chances are you will get to the point where you must stop running as part of your rehabilitation. The bottom line is this: running should not be painful. If you are having knee pain with running, we would love to help you get back to your full potential. Give us a call and set up a courtesy consultation to learn more about how we can help you run without knee pain and reach your training goals.