With the arrival of spring and summer in Michigan, the recreational running season bursts into action. Streets, sidewalks, parks, and tracks become vibrant as people enthusiastically embrace the joy of running.

While running is undeniably an excellent form of exercise, it involves impact and can lead to various overuse injuries. Among the common issues I encounter in my practice, shin splints, stress fractures, plantar fasciitis, and hip, thigh, and ankle tendonitis are prevalent among runners. However, let’s focus on the most frequent “running problem” I come across: “Runner’s Knee.”

What Is Runner’s Knee?:

This term refers to the discomfort, pain, and issues that arise around and behind the kneecaps in runners and athletes. Technically known as patellofemoral syndrome, it encompasses several distinct clinical conditions that can occur:

  • Tendonitis of the patellar or quadriceps tendon
  • Chondromalacia Patella, which is the term used to describe softening and fraying of the cartilage behind the knee cap.
  • Patellar Maltracking that results in chronic pain and/or actual dislocation of the knee cap.
  • Apophysitis is the term used to describe irritation of the small growth plates in the front of the knee. It occurs in children and adolescents. One of its other names is Osgood Schlatter’s Disease.

Symptoms:

Typically, symptoms manifest as a persistent achy sensation beneath or surrounding the kneecap (patella). The pain may arise during or after physical activity. In instances of patellar instability, the kneecap might even shift out of its groove. Additional symptoms such as popping, catching, and swelling can also be experienced. Activities involving running, jumping, walking up or down stairs, kneeling, squatting, or prolonged sitting with a bent knee often elicit pain and discomfort.

Causes:

Athletes engaged in running, jumping, tennis, basketball, volleyball, and similar sports subject their knees to significant strain. I often explain to my patients that the front of the knee is particularly susceptible to issues due to the immense stresses it endures. Activities like running and jumping can generate forces surpassing seven times the body weight around the kneecap! Also, females are generally more susceptible to patellofemoral syndrome due to differences in leg alignment compared to males.

The front part of the knee is a highly intricate and delicate structure. Various factors can contribute to the development of runner’s knee and patellofemoral syndrome, such as:

  • Misalignment or maltracking of the kneecap
  • Excessive training or overuse
  • Flat feet
  • Tightness, imbalances, or weakness in the muscles of the thigh and hip

Typically, it is a combination of these factors that leads to the condition. Many of my patients exhibit an imbalance between strength and flexibility, alongside the other factors mentioned earlier.

Prevention

Maintain fitness
Maintaining good overall physical condition is crucial for managing and preventing patellofemoral pain. If you are overweight, it may be necessary to shed some pounds to avoid excessive strain on your knees.

Stretching routine
Prior to any exercise, including running, begin with a 5-minute warm-up followed by stretching exercises. Focus on stretching the supporting structures around the front of the knee, especially in the prone position. For instance, when lying face down, gently stretch the front of the knee by grasping the ankle of the affected leg. Remember to stretch both before and after exercise.

Gradual training progression
Avoid sudden, drastic changes in exercise intensity. Gradually increase the force or duration of activities. Adhering to the 10% rule can be helpful—aim to increase activity duration or intensity by 10% per week.

Appropriate equipment
Opt for running shoes that provide excellent shock absorption and are well-constructed. Ensure proper fit and check that the shoes are in good condition.

Correct running technique
Maintain a slight forward lean and keep your knees bent while running. Additionally, choose clear, smooth, resilient, even, and reasonably soft surfaces for running. Never run straight down a steep hill; instead, walk down or employ a zigzag pattern.

Treatment

The RICE formula is a valuable initial treatment approach for runners experiencing discomfort or pain. Here’s how it works:

  • Rest: It’s essential to avoid putting excessive stress on the painful knee. The level of rest required may vary based on symptom severity, ranging from using crutches to modifying activities. Rest is often crucial, although it’s not always what runners want to hear!
  • Ice: Apply cold packs or ice wrapped in a towel for short durations (15 to 20 minutes) multiple times a day.
  • Compression: Utilize a knee sleeve that allows the kneecap to remain exposed. This sleeve offers support and gentle compression.
  • Elevation: Whenever feasible, elevate the knee, especially if swelling is present.

For improved effectiveness, combine the RICE formula with NSAIDs like aspirin or ibuprofen. If your knee doesn’t improve, consult a doctor. Physical therapy is the key treatment for unresolved issues, focusing on achieving a balance between strength and flexibility. Additional elements, such as proper footwear, orthotics, and advanced braces, may also be included in the treatment.

Don’t let “bad knees” stop you from running! There are options available. Injections can reduce inflammation and provide knee lubrication. Surgery can fix cartilage, tendonitis, and improve kneecap tracking. Surprisingly, cartilage transplantation can fill those knee “potholes.” Innovative treatments like Platelet Rich Plasma (PRP) and Stem Cells help tackle arthritis and cartilage issues for runners who refuse to hang up their shoes…

So, there you have it – have fun and stay fit as you run your own safe running program this spring and summer!

Dr. Joseph Guettler is an orthopedic surgeon who specializes in sports medicine, as well as surgery of the knee, shoulder, and elbow. His office is located in Bingham Farms, MI. Visit www.miorthosurgeons.com for more information on Dr. Guettler and his practice, Michigan Orthopedic Surgeons.