How to deal with that niggly ‘runners knee’

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Typically this time of year is when we will see a bunch of runners coming into the clinic complaining of some niggling knee pain that is affecting the comfort of their running. The weather is much better in summer and we’re all realising we could afford to lose those extra kilos weve packed on over the christmas period and generally make some healthy lifestyle changes, so running is a easy entry point that can become quite enjoyable once you begin to feel the fitness benefits!

The ‘runners knee’ presentation describes niggling knee pain you might feel at the front, underneath or just inside the patella and usually boils down to there being some joint irritability and dysfunction within the patellofemoral joint. Many structures influence the push and pull of the patella (kneecap) in different directions, and when these are out of balance, the movement of the patella within the intercondylar notch of the femur is affected which leads to pain. This occurs due a few things which you can reason along with to try and determine what might have gone wrong in your situation! 

Total Workload Spike

A spike in your total workload is often the key contributing factor when dealing with runners knee. This refers to an acute increase in how many kilometres you may have ran, your time spent running or a change in the type of running you are doing. Increasing these things too soon while possibly dealing with underlying dysfunction will commonly result in you developing some knee pain. This should theoretically be easy to modify, as you can simply reduce the amount of volume you are doing week to week and build it up slowly. There is no golden rule here, but use your current and previous exercise history to gauge where you should be starting. For complete novice runners, a program like a ‘couch to 5k’ can be a really nice way to gently increase your running load.

Underlying hip, knee, ankle and trunk dysfunction

This refers to the more ‘physio’ type issues that we commonly will address in the clinic. Mobility issues restricting ankle and hip range of motion can be big contributors, as can muscle weakness or side to side imbalances, typically seen in the hip abductors. Lacking satisfactory muscle strength can cause movement dysfunction seeing an imbalance in the forces acting on the patellofemoral joint upon foot strike. Some hands on treatment to get the ball rolling followed by some corrective exercises can be an invaluable part of dealing with runners knee.

Running Technique/Movement Pattern

Everyone seems to have their own unique running style, and it is certainly something that can be confusing to change. Ultimately the first two components here are more important, but if weve addressed those to minimal effect, then this is where we would look next. Initially, making changes to stride length by decreasing step length and increasing cadence (steps per minute) is a good place to start as overstriding can increase impact forces through the joints. Trying to achieve a forefoot or midfoot strike goes hand in hand with this and should distribute some more load throughout the lower limb. A cadence between 170 and 180 steps per minute is what you should be aiming for. Beyond this a running assessment is needed to really hone in on the points that may be contributing to your knee pain.

External Environment

Finally, the last (and very small) piece of the puzzle is addressing the external factors during our running. Surface can play a role, as grass can be more forgiving than road running. Flatter surfaces may also be gentler than running slopes and declines. Footwear can also play a small role, but there is really no consensus about what style of shoe is best. They all have pros and cons, but for first time runners it makes sense to go with something that has more cushioning, while experienced runners may opt for a lighter, more minimalist shoe to improve economy.

Niggling knee pain can be really frustrating especially when it starts to interrupt some of your hard earned progress you had made leading up to it. Its always valuable to get assessed by an expert as they will be able to delve deeper into some of the contributing factors mentioned above, and as we see a lot of it, we become quite good at dealing with it, so give us a call if this sounds like you! 

Dan Ryles


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