Tips For Dealing With Knee Pain

Some of you may be training for the Times Colonist 10k, the Victoria Marathon or just trying to get into a running routine  and find you're "running" into some road bumps like knee pain.  If you are suffering from a lingering or chronic knee pain it needs attention before it becomes serious enough to hinder your lifestyle.  In this article we'll cover three of the most common sources of knee pain: Patellofemoral Pain Syndrome (or Runner's Knee), Patellar Tendonitis, and IT Band Syndrome.  Let's go over some of the causes, symptoms and treatments.

Note: None of the information in this article is intended to replace the advice or direction of a qualified medical professional, physical therapist or trainer.  If you are experiencing severe or acute pain in your knees, visit your doctor to get a proper diagnosis before beginning any form of corrective exercise.

Runner's Knee

One of the most common forms of knee pain is patellofemoral pain syndrome - often called "Runner's Knee".   This is pain that occurs directly surrounding or under the knee cap, and should not be confused with pain directly in the patellar tendon (patellar tendonitis) above the kneecap which we will address later on.

Runner's knee is used to classify a number of conditions caused by the kneecap (patella) tracking improperly and grinding against the thighbone (femur).  The way your kneecap moves as you bend your leg is most greatly influenced by the relative strength and flexibility of the muscles surrounding the knee.  These include the "quads" or thigh muscles, hamstrings, IT band and calves.  Most people with runner's knee have overly tight hamstrings, IT bands and calf muscles, and have relatively weak quads.  This causes twisting of the knee joint during load-bearing activities (read: walking, running, climbing stairs, etc.) and the kneecap starts rubbing against things it shouldn't be.

Over time this leads to pain and inflammation in the knee and if left untreated can lead to serious damage to your bones and connective tissue.

Runner's knee can be caused by:

  • overuse/overload
  • improper footwear
  • walking/running  downhill
  • excessive pronation or supination of the foot
  • tight IT band/hamstring
  • weak vastus medialus(inner part of front thigh muscle).  

The pain comes from the kneecap (patella) tracking improperly, causing it to grind against the thighbone (femur) leading to inflammation and over time serious damage to your bones and connective tissue.  Symptoms include pain under or on the inner corner of the knee cap, aggravated by long periods of sitting, running downhill, descending stairs, wearing flat shoes or standing on hard surfaces.  If left untreated, runner's knee can cause serious damage including osteoarthritis and chronic pain, limiting the range of knee flexion.

Steps To Treating Runner's Knee


 1.     Strengthen & Stretch
As we stated before, the most common cause of runner's knee is weak and/or tight muscles around the knee.  A qualified physical therapist, exercise physiologist or trainer can put a program together for you that can address imbalances in the muscles of the leg.
 
2.     Relative Rest
If you run or participate in any high-impact activities, you'll need to reduce the amount of stress being placed on the knee joint long enough for the inflammation to decrease.  You can keep your cardiovascular strength high by doing low impact training such as swimming or using an "elliptical" training machine.
 
3.     Ice It
After any sort of strenuous activity, or any time you feel pain or discomfort in your knees, take 10 minutes and ice it to reduce any swelling.  This will vastly improve the rate at which your knees return to normal and can provide temporary quick relief.
 
4.     Get New Shoes
Chances are those three year old runners you wear when you're exercising probably didn't provide enough support when you first bought them, and now they could very likely be the major contributor to your knee pain.  Check the bottom of your shoe for excessive wear on the inner or outer edge of the sole, and make sure that you buy your shoes from a reputable and knowledgeable source. 

Runner's knee can be relatively easy to fix, the vastus medialis needs to be strengthened, IT band and hamstrings need to be stretched and avoid all activities that strengthen the vastus lateralis or outer part of front thigh.  For severe cases strengthening exercises may have to be done up to four times per day until the nervous system starts responding and pain starts to decrease.  This type of knee pain should be taken very seriously and worse case scenarios can be completely prevented when treated.

Patellar Tendonitis

Another common source of knee pain is Patellar tendonitis, sometimes called "Jumper's Knee", which is swelling of the patellar tendon (the tendon that connects your kneecap to the thigh muscle) . This is caused by high impact activities that put stress on the tendon, causing microscopic tears which become more and more numerous leading to pain and inflammation.

Activities such as running, too much jumping and aerobics, walking or running downhill or any repetitive exercise can lead to patellar tendonitis.  Symptoms include pain around the knee cap, tenderness, pain when squatting and pain that moves around above the knee.

Patellar Tendonitis can be caused by:

  • overuse/overload (especially jumping)
  • a sudden increase in physical activity
  • being overweight
  • muscular imbalances in the leg
  • tight leg muscles
  • weak vastus medialus(inner part of front thigh muscle). 

Treatment is similar to treating runner's knee, including reducing the impact to joint, varying your activities, avoiding hills and repetitive exercise.

IT Band Syndrome

Lastly, there is IT band syndrome, an inflammation of the iliotibial band (a muscle that runs from the outside of your hip to the outside of your knee) caused by excessive friction against the knee joint.  This leads to pain felt at the side of the knee and can appear at the hip joint as well.

IT Band Sydrome can be caused by:

  • a difference in leg length
  • sitting cross-legged
  • a sudden increase in physical activity
  • poor footwear
  • poor foot mechanics
  • muscular imbalances in the leg
  • weak hip abductors (outside of hip)
  • tight leg muscles
  • running on cambered surfaces (hills)

 You will be able to tell if you experience sharp stabbing pain or dull ache in the outer side of the knee or if it is aggravated by running or downhill walking. Treatment includes good footwear, avoiding running on uneven surfaces, decreasing the intensity and time of exercise, strengthening your outer hip and stretching your IT band and hamstrings.

 For more information on specific strengthening or stretching exercises please contact us to book a free fitness consultation session at 250.383.6946