Runners often suffer recurring injuries or niggles which impacts their running. Most people expect these things as natural consequence of running.
Runner’s knee, also known as Patellofemoral Pain Syndrome (PFPS) is possibly one of the most common and often most persistent of these “niggles”.
So What Does it Feel Like?
Patellofemoral Pain Syndrome is pain arising from the region of the kneecap or adjacent soft tissues. In my experience if I ran too far, my knee would feel like it was seizing up, like the joint was rusting somehow and it was painful to bend the knee. It would linger even after stopping the exercise. In the day or two following it would be painful if I tried to squat down or climb stairs. I also would feel it if I sat too long.
But if I rested it and avoided those irritating things it generally would settle down until the next time. Honestly it was a bit of a vicious cycle.
So What Causes it Anyway?
PFPS can be from trauma to the patella (knee cap) but more often than not it is the result of several factors:
- Overuse and overload of the patellofemoral joint (i.e. training errors)
- Anatomical or biomechanical abnormalities
- Muscular weakness / imbalance or dysfunction
So it is understandable why, when so many things are at play that PFPS can be a bugger to settle down.
How to Beat the Ache
There are things in PFPS we can change and there are things that we can’t. It is often important to have a trained health professional, who is skilled at determining the underlying contributing factor, help you develop a plan to overcome persistent knee pain.
My top tips are:
1. Look at the Load
It is important that when you are running, or really implementing any new exercise, that you allow your body time to acclimate to the activity so that your body can match the increased demand.
What this means in real life is you need to have plan that allows rest, active recovery and where appropriate strength and conditioning exercises to help the body match the demands on the knee.
Having a gradual training plan it avoids the Boom and Bust cycle.
2. Work on the underlying muscle weaknesses
The most common weakness for people experiencing PFPS is the Quadriceps, or the muscles at the front of thigh. Strong quadriceps are important in absorbing the load exerted on the knee and helping the patella track optimally in the groove of the femur.
The other major weakness that commonly needs to be addressed are the one found in the hip. Having strength in the external rotators of the hip helps ensure the alignment of the lower leg is preserved and less stress is placed on the knee.
3. Work on the tight areas.
Typically, with people suffering from PFPS there are a few structures and groups of muscles which are tight. These include iliotibial band, hamstrings and calves. Stretching or using recovery techniques like foam rolling, following a run can help alleviate symptoms around the knee. However, stretching in and of itself will often not stop the knee pain from recurring, because more often than not, the reason these muscles become tight is they lack the endurance to do their job effectively. So, it becomes essential to work on the endurance of these muscles.
My 7 Go To Exercises for Knee Pain
Long Arc Banded Quads
- Place a TheraBand around a solid object and placing a chair over the band with back of chair to the fixed point
- Sitting on the chair with feet flat and back against the back rest
- Place your foot inside of the band and loop the band around the foot to stop it sliding up your leg
- Whilst keeping the back of your thigh in contact with the chair, extended your leg out until leg is completely straight and then return to original starting position
- Perform 12-15 repetitions and then swapping legs -To increase difficulty, move the chair further away from the fixed point to add more resistance through the band
Wall Facing Sit to Stand (double/single)
- Positioning the chair facing the wall, Seated on the chair with feet hip width apart
- Keeping your arms across your chest
- Pushing through your heels in order to stand in a controlled manner whilst avoiding contact with the wall
- Slowly reversing the movement back down to the chair in a controlled manner
- Perform 12-15 repetitions
- To Increase the difficulty of this movement, perform with 1 leg, whilst continuing to maintain the control of the movement and with minimal shifting of the hips
Bridge with Knee Extension
- Lying on your back with knees bent and feet hip width apart and flat on the ground
- Press through your heels to lift your hips up
- Making sure your hips are level with your trunk avoiding any extra bend in your lower back
- Holding in this position with our hips up, lifting 1 leg off the ground and extending it out straight whilst trying to minimise how much our hips move or drop
- Then reverse the movement back down to the ground
- Perform 12-15 repetitions on each leg
- Lie down on your back and place your feet up on top of a box or chair
- With a small knee bend push through your heels to lift your hips up off the ground
- Lift your hips up until level with legs avoiding any extra curve in the lower back
- Keep your feet straight making sure they don’t turn out
- Slowly control body back down to the ground
- Perform 12-15 repetitions
- To increase difficulty perform on with only 1 leg on the box and the other leg is raised above the body and perform on both legs
Star Side Plank
- Lying on your side, forearm placed directly under your shoulder and feet positioned on top of each other with top arm placed on your hips
- Keeping a straight body, press through your forearm and body foot to lift your hips up off the ground
- Once straight and stable position is achieved raise your top leg to form a star
- Keeping the top leg straight and in line with the rest of the body
- Slowly reverse the movement back down to the ground
- Perform 12-15 repetitions on each side
Wall squat Calf Rises
- Placing your back up against the wall with feet hip width apart
- Slide down the wall to achieve a squatting position at approximately 90degrees of knee bend
- Holding in this position slowly rise up on to tip toes and slowly control heels back down to the ground
- Perform 12-15 repetitions whilst holding the squat position
- To increase the difficultly of this exercise perform with only 1 leg in contact with the ground at a time
Banded Terminal Knee Extension
- Fix a TheraBand around something solid and then loop the band around the back of your knee
- With the opposite leg positioned further in front of the banded leg, make a stable base of support
- Slightly bend the banded knee with heel lifted off the ground
- Then pushing the heel down towards the ground, straighten the knee and feeling the resistance in the band
- Squeezing your quadriceps in this position and keep your bodyweight through this leg
Other Things that May Help
There are also a couple other things which may help as you work on improving your strength and conditioning. These include:
If your foot has a tendency of rolling in, then a pair of orthotic may help improve your lower limb alignment and help reduce the stresses on your knee. Often a pair of off-the-shelf foot orthotics will do the job and as they are not too expensive it would be worth a try.
Using RockTape™ can be beneficial in supporting the kneecap and facilitating the surrounding muscles. The flexibility of the tape ensures that the knee can move through its full range of motion. The gentle adhesive also minimises the risk of allergy.