As part of a quick and thorough method of treatment, first address the biomechanical causes for the pain. Then utilize the following strategies to quickly recover from the pain in order to keep training and running at a high level.
The Woes of Runner’s Knee
PFPS can be quite painful and significantly affect your ability to run or move properly. The cause of the pain is often associated with the patella (knee cap) improperly tracking in the femoral groove.
This can occur for many reasons, but the most common causes are:
- Poor quadriceps strength (particularly the inner or medial quadriceps).
- Poor hip abductor and/or hip external rotator strength.
- Improper foot biomechanics during the single leg stance phase of the gait cycle or the mid foot strike during running. The most common issue within the foot is usually overpronation (when the feet excessively roll inward and cause the knee to roll inward as well during each step). Overpronation is more common among females although males experience it as well. Women may experience overpronation due to the angle of their hips in relation to the knee. A woman’s pelvis is typically a different shape to allow for child bearing. The larger “Q-angle” associated with the hip and knee can cause increased strain on the knee.
PFPS (runner’s knee) symptoms include:
- Pain that will typically increase when going downstairs. In more severe cases, going upstairs is also very painful.
- Pain with squats, lunges, knee extensions or other plyometric activity.
- Pain typically worsens with prolonged sitting. The longer you sit in one position, the worse the pain becomes.
- Grinding, popping, clicking and/or cracking.
- Pain can be anywhere along the patella (knee cap), but it’s typically associated with anterior knee pain or medial patellar pain.
In many cases, a very thorough warm up may allow you to participate in activity. However, the pain may worsen again later that day or the next day. To insure a speedy recovery and avoid a chronic condition, seek help or guidance quickly if you’re experiencing these symptoms. For the best result, the treatment plan should be multifactorial.
How to Self-Treat Runner’s Knee
- Improve your quad and your hip strength. Please refer to Patellar Femoral Pain Syndrome Rehabilitation Exercises.pdf for my recommended exercise program which is designed to improve quad and hip strength. Weak hip abduction and hip external (lateral) rotation muscles can significantly contribute to PFPS. The purpose of the lateral and external rotators of the hip is to prevent internal rotation (rolling inward) of the hip and knee. My recommended exercise program will help to improve your strength and insure proper patellar tracking.
- Warm up prior to exercise. I recommend that you increase your normal warm up time to at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients.
- Cool down. After performing your exercises, take extra time to cool down and stretch. This is an excellent time to work on self-mobilizing tissues. Allow time for your heart rate to return back to normal before you actually stop and begin to stretch or mobilize the tissues. I have found that the best time to work on spot training my weak areas is during my cool down. This would also be an excellent time to work on my suggested rehabilitation exercises (see above).
- Self-mobilize the tissue. Myofascial release of the quadriceps muscle is an important component in order to relieve the pain and reduce the pressure and tension through the patellar femoral tendon and joint complex. I tend to use the foam roller for the larger part of the quadriceps. I also use a tennis or lacrosse ball to aggressively work the tissue above the patella. You can use your hand to press the ball in and work it around the tissue. To use the weight of your leg for a more aggressive mobilization, place the ball on the ground and mobilize the tissue with your leg on top of the ball.
- Mobility bands, such as the Rogue Fitness VooDoo X Bands or EDGE Mobility Bands, are a novel way to self-mobilize the tissue of quadriceps. The use of a mobility band not only helps to mobilize the tissue, but it affects blood flow to the area and speeds up healing. A mobility band also helps to reset some of the receptor cells in the muscle tissue which cause excessive muscle tightness. The following video, Patella femoral pain voodoo, demonstrates how to apply VooDoo X bands. (If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of deep compression.)
- Kinesiological taping. The purpose of the tape is to assist the patella in its tracking. I have had luck using Kinesio Tape and Mummy Tape brands. There are many different methods to utilize the tape. The easiest method to apply is to tape in a medial direction across the patella approximately 30 minutes prior to exercise or activity. First measure how much of the tape you intend to use. Start from the outside of the knee cap to half way around the leg minus about an inch. Cut the strip, then round the corners on the edge of the tape. This helps the tape to not catch onto clothing. Apply the tape without extra stretch to the first half of the knee cap, then apply between a 50-75% stretch for half of the tape medially toward the inside of the leg. With the last of the tape, apply without a stretch to the inner side of the leg. (You could also utilize Spider tape, KT TAPE or Rock Tape.) To visually learn how to apply the tape, please refer to Kinesiological Taping for Patellar Femoral Pain Syndrome.pdf. For application and removal tips, please refer to Skin Care with Taping.pdf.
- Have your gait analyzed while running. Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic. How is your foot striking the ground? Is it rolling in (landing flat footed)? Does your knee rotate inward or stay tracking in line with the foot? Ideally, the knee tracks in line with your second toe. If your foot isn’t maintaining a proper position during its mid foot strike, a new pair of shoes may be indicated specifically to control pronation. Hip weakness could also allow the knee to roll inward. Quality shoes or over-the-counter orthotics can help you to maintain proper positioning during the foot strike. Therefore, reducing the abnormal forces on the knee.
- Start a supplement. Many herbs help to reduce inflammation and pain. CapraFlex is one of my favorite supplements. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently to help heal from an injury. I recommend that you try it for 30 days to see if it improves your pain. Tissue Rejuvenator by Hammer Nutrition is another option similar to CapraFlex. It contains glucosamine and chondroitin as well as a host of herbs, spices, and enzymes to help support tissues and limit inflammation. I recommend taking either CapraFlex OR Tissue Rejuvenator—don’t take both. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)
Patellar Femoral Pain Syndrome (runner’s knee) is very painful condition that limits your ability to train and race, but it can be self-treated if you handle your pain and symptoms quickly. Get to the heart of the biomechanical issues which are causing the pain by working on your running form and proper strength. Utilize the mobilization and taping techniques to recover faster as you keep training and addressing the causes for the pain.
If you’re not experiencing relief after aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing PFPS. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.
Perfectly times advise. I am having very mild issues that I want to treat before the become serious issues so I am researching the topic.
Glad that I could help! Please let me know if you have any specific questions. Good luck!
You say several times in your article that it is important to treat it right away. What happens if you’ve had it for 9 months and now want to get started with treatment?
Great question. It is never too late to start working on treatment. The reason why I mentioned to start treatment right away is that the longer the injury lingers, the more difficult it can be to resolve. As time passes, your body tends to compensate for pain and you start to move differently and the body’s tissues change. So you have to work through all the potential causes that started the issue in the first place as well deal with any compensations or changes that occurred as your body naturally compensated for the issue. Although very reversible, it typically takes longer to see a complete recovery. So it is always best to deal with a problem early.
Another epic guest post Dr. Ben!
Thanks, Trevor! I’m more than happy to help!
You helped me a few years ago to eliminate my knee pain. It’s been rearing it’s ugly head again over the summer and is finally starting to effect my training. I researched your Facebook page till I found this reference.
It’s information you have already given me so I’m reprinting and I just used the foam roller on my quads…ouch. I will incorporate this routine in between my strength training days…
How long should I be rolling? And should I be icing? Or heat? And is there any knee exercises I should doing as well?
Great article…I’m trying to decide whether to pull the plug on my first marathon that I’ve been gearing up for or give it a shot. I just listened to the podcast about Trevor’s Tupelo marathon–the one that got away–and found this. After listening to over 50 episodes in the last 3 months (I was late to the game but now feel like I’m part of the family on the epic road trip), this was the one that most impacted me because it speaks to the inner fears we runners have of overtaxing the body coming into conflict with our desire to go out there and achieve things that were previously out of our reach. I didn’t realize just how important my goal of finishing a marathon was to me until I had to consider the idea of pulling out. I knew I was too emotionally caught up when I started tearing up when I heard Katy Perry’s “Roar” and wanted to toe the line so desperately to be a champion in my own mind (super cheesy, I know). But we still all have to make a decision and we have to live with the consequences of that choice.
So, technical question from the article. Reading this, my assumption would be that Kenisio tape or mobility bands (but not both simultaneously) would be a good way to try out the legs after a few weeks of rest. Use one at a time, but not both? How much rest should I give it before trying to run again?
Yes it is always hard to know when to postpone and when to push through. It really depends on severity of symptoms. Especially with runner’s knee. Other considerations would be upcoming events or other races that a prolonged recovery may affect.
As far as your question goes…..Mobility/compression bands are to be used as a specific treatment. The treatment is only for a couple of minutes and should be done 1-2 times a day at most. The Kinesio type taping is something to use during your running or training. The hope is that the kinesio tape will help temporarily improve the biomechanics of your running which lead to the pain. The kinesio tape is then a tool that you use to help rehab the actual cause of the issues which is often times either muscle imbalances or running mechanic issues or both. So in short both interventions can be used as the bands are done in conjunction with the rehab routine and the kinesio tape is used during running or other training activities to reduce pain. Hope that helps to clarify.
Hi there! First post in a long time, I see! Thanks for such an awesome article. I, too, am struggling with knee pain in my left knee on the outer bottom edge of the kneecap. It’s worst when going down stairs or jogging/running. I noticed it as stiffness after my 17mi long run 4 days ago, took a day off, ran easy the next day, and the following day did a workout. Over the days it went from stiff to sore to quite sore.
I’m running Philly in the end of November and hoping to PR or better yet, BQ. Seems like a long way out, but i know these types of injuries only improve with significant rest – I’m not sure I have time to take that time off and still perform at my best.
I feel like I’m nipping it in the bud – only have run about 12 miles over two days of running since noticing the pain. What should my course of action be, and what should I prepare for in terms of altering my training?
As always, many thanks for sharing your knowledge!
HI Hannah, Great questions. You need to find out why you are getting the pain in the first place. Sounds like Patellar femoral pain syndrome. This is commonly caused by hip weakness and poor footwear usually leading to poor foot mechanics. Training all depends on symptoms. I would start with the appropriate cross training and hip strengthening exercises and address any potential footwear issue. You may also consider kinesiotaping or a new brace system I am fond of that helps in these conditions called the NuNee. Here is a link. https://nuneeshop.com/ Hope that helps!!!