Runners knee essentially arises from an imbalance between the various muscles pulling on the patella (knee cap) – some get too strong and overpower their counterparts resulting in the patella moving or tracking incorrectly. This starts off being painful in and around the patella as it doesn’t slide correctly in the groove of the knee joint, but can quickly spread pain into other areas as the muscles continue to pull it off track and compensatory patterns begin in the leg.
The pain usually starts around the outer edges of the knee and patella, and may spread up the thigh or down into the shin. It is worse with running and cycling in particular, although all exercising may cause knee pain, and then it is usually fine with rest. If this sounds like your knees, and you lead an active life, you may just have yourself a touch of Runners knee.
Runners Knee is best diagnosed clinically, and by that we mean using the pain pattern and presentation, along with palpatory findings in the front of the thigh to confirm Runners Knee. It will not show up on X-Ray, as there is not a bony problem in this situation; it is simply a temporary malignmnent of the patella on the front of the knee. Ultrasound is an option for helping to diagnose Runners Knee, as the continued friction under the patella when it tracks incorrectly can cause inflammation in the bursa (a small fluid filled cushion inside the knee) which can be identified on ultrasound.
The main group of muscles that causes the trouble is the quadriceps group – 4 large strong muscles that primarily control the knee. What usually happens, is the outermost of the quads becomes significantly stronger than the innermost section of the quads, resulting in the patella being pulled slightly towards the outside. Sometimes, it can be as simple as strength training to isolate the inner quad and stretching to the outer quad to reset the balance and correct patella tracking.
Although Runners Knee usually arises from a fairly simple imbalance, we need to also consider why that imbalance has come about. If you are simply using one part of your quads more than the other, then the simple solution of stretching and strengthening may be enough. However, let’s say one leg is slightly longer than the other, or you are slightly knock-kneed, or perhaps you are running with plantar fasciitis as well, then the pressures on your knee will be altered and the muscles will be responding accordingly. Recovering form Runners Knee will require not only the strengthening and stretching approach, but also treatment to resolve the other musculoskeletal factors that are contributing.
Virtually all cases of Runner’s Knee respond well to osteopathic treatment, and within 2-4 treatments you can expect to be well in the road to recovery. The aims of treatment are to resolve the localised inflammatory response at your knee and identify and address any underlying postural and body alignment issues that may be contributing to the problem. Rest and ice can be very helpful, particularly in the first phase of injury, and appropriate use of Non-Steroidal Anti Inflammatory Drugs (NSAIDS) can also be a good option. The main concern around NSAIDS with this type of injury is that sometimes they work too well – if you end up with no pain then in all likelihood you will keep running on it, and although there is no pain in your knee there is still damage occurring to the underlying structures.
Sometimes, for a short period of time it is necessary to give your knee a break and step back from your running. Often however, with good treatment you will be able to continue training as long as you keep up your self-care with stretching and using ice therapy at home. It can be so discouraging to find yourself injured, and so often it is just when you are starting to enjoy running, or reaching a certain milestone with your training, and the last thing we want you to do is stop. The benefits of exercising are so wide ranging, from your physical to your mental health, and we will do everything we can to help you keep going. Don’t let a nagging knee pain stop you – this is very treatable and you can get back to running pain free in no time.