A blog by runners. For runners.

Sore knees? You may have runner’s knee

Knee pain is one of the more common symptoms experienced by runners I see at my practice. Often times the symptoms are caused by a condition called runner’s knee, something I’ve struggled with myself for years. Runner’s knee is the lay term for Chondromalacia Patella or Patellofemoral Pain Syndrome. It is very common among runners, jumpers and anyone who engages in activity that puts heavy stress on the knees.

Chondro means cartilage, malacia means softening, patella means knee cap and when put together it means a softening of cartilage underneath the knee cap.

Symptoms of Chondromalacia Patella, aka “Runner’s Knee”

  • Aching in the front of knees
  • Cracking or popping of knees (more noticeable when going up and down stairs or during and after hill or stair training)
  • Knee pain after rising from a long sit

To understand this condition better, let’s examine the anatomy of your knee, which consists of the patella-the thickest piece of cartilage in the body, as well as tendons and ligaments that allow the knee to endure tremendous levels of stress. The patella sits on a track or a groove which allows your knee joint to bend and your leg to function properly as you walk and run. When the knee cap does not track properly in the groove, it can cause the symptoms listed above.

For many runners, the most likely culprits causing runner’s knee are muscular imbalance, overuse and injury. When muscles are not in balance the stronger group(s) compensate for the weaknesses of others to function properly. This adds stress to those muscles and can lead to poor kinematics. Poor kinematics means a compromise in the fluidity of your stride and this can lead to knee pain. In my experience, the inside quad muscle is much weaker than the middle and outside muscles.

The other two factors — overuse and injury — are the other two factors and are caused by training too much and not allowing the body to recover naturally during training intervals.

Alternatively, individuals may possess genetic predispositions that increase the likelihood of runners knee. Having flat feet or pronated feet can cause uneven weight distribution which can cause elevated stress on the knee. Another common predisposition is a malalignment of the knee. This occurs when the patella tracks outside the natural groove in the knee and it can cause unequal wear.

Treatment Options

I have runner’s knee and it developed because I used to be very active in athletics and I am fairly active now. If I stretch properly and make sure I am strengthening my muscles equally the pain subsides. If I don’t stretch and strengthen equally, my knee starts “acting up.”

In general runners should abide by these guidelines:

  • Stretch, stretch, and repeat (try some yoga)
  • Adjust your routines and strengthen muscles evenly especially your vastus medialis (inner quad muscle) (less hills, stairs, change running surfaces for less impact, etc.)
  • Make sure all shoes and insoles are right for you and your training habits
  • Take Tylenol or other OTC pain relievers as needed if medically able
  • RICE  Rest, Ice, Compression, Elevation
  • Bracing/Taping -trial to see if it helps, can improve patellar tracking
  • Glucosamine and Chondroitin
  • Supplement for arthritis- Note: While they didn’t work exceptionally well for me, they have definitely helped others. However, if you are considering, I recommend a two month trial followed by stopping it for a few weeks to see if it actually worked for you.

I’ve been asked by patients about corticosteroids, but they are not typically used as an initial treatment option.

If the pain persists for more than two weeks after trying the above treatment options, it is time to see a doctor and get X-Rays to get a better idea of what’s happening.

Generally, surgical or invasive treatment is not needed to treat runner’s knee, but alignment abnormalities, focal cartilage defects, and ligament damage can occasionally call for surgical procedures.

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Written by Dr. James Nace. James Nace, MD is an orthopedic surgeon-joint replacement and doctor of general orthopedics specializing in hip, knee and shoulder joint preservation and reconstruction. He practices out of the Rubin Institute for Advanced Orthopedics at Sinai Hospital of Baltimore, Maryland. Throughout his career as a physical therapist and orthopedic surgeon, Nace has gained the most satisfaction from treating runners and all types of athletes for their injuries and helping get them back to training and competing.