Description of Runner’s Knee

Runners knee refers to a junk-basket term of multiple pathologies that can cause knee pain. Most commonly they are due to an overuse-type problem, whereby a few of the hamstrings become too tight or a quadriceps becomes weak and the tissues around the knee become irritated. This can also include overuse-type syndromes, which can cause friction irritation where structures cross the knee, such as iliotibial band friction syndrome.

Symptoms of Runners Knee:

  • Pain behind or around the kneecap
  • Pain bending the knee
  • Swelling
  • Pain that becomes worse when walking downstairs or downhill
  • Pain along the outside of the knee after running over two miles

Are you experiencing runner’s knee symptoms?

There are two ways to initiate a consultation with Dr. LaPrade:

You can provide current X-rays and/or MRIs for a clinical case review with Dr. LaPrade.

You can schedule an office consultation with Dr. LaPrade.

(Please keep reading below for more information on this condition.)

Treatment for Runner’s Knee

In the majority of cases, the treatment for runners knee is non-operative. This would include a program of stretching, cross training, and low-impact exercising. If one does not have any improvement over time with cutting back activities and cross training, such as cycling, elliptical use, or swimming, then one should be evaluated to determine if there is an underlying cause that is contributing to the symptoms.

Sometimes, a localized cartilage defect or a meniscus tear can cause the knee to swell with activities, which can lead to the same type of symptoms that one sees in runners knee. Therefore, if cutting back on activities is not useful, an evaluation to include a clinical exam, X-rays, and possibly an MRI scan may be indicated.

Runner’s Knee Injury FAQ

Runner’s knee can be one of  multiple potential pathologies that can cause pain around the front of the knee and also the soutide of the knee associated with running. In the majority of times, they are due to overuse or a muscle imbalance that can be addressed.

1. What is runner’s knee?

Runner’s knee is a term that is often used to describe pain that can occur in the front or the outside of the knee with activities. It is often due to overuse, especially on harder surfaces. In addition, bony geometry such as feet that are not lined up or knees that are malaligned can also cause extra stress over time with running. In addition, if one’s thigh muscles are not strong enough, there would be extra load placed on the knee, so making sure one’s thigh muscles are strong enough to have excellent absorption is a key to prevent some of the symptoms of runner’s knee.

2. Can runner’s knee be curable?

Because runner’s knee is a wastebasket term of multiple different things that can happen in the front or outside of the knee, it is difficult to determine if it is curable based only on the history.  If it is due to a muscle imbalance, seeing a physical therapist and learning how to properly realign the muscles may be indicated. If it is due to overpronation of one’s feet or other issues, using orthotics may also make it “curable”. If it is due to chondromalacia, which is arthritis, then following a proper rehabilitation program and possibly considering surgery may be a way to improve his symptoms. In addition, if it is due to iliotibial band friction syndrome, having a proper rehabilitation and program to stretch out the iliotibial band may alleviate the symptoms.

3. What exercises help a runner’s knee?

Having proper strength of one’s lower extremity such as not to have any significant overload is important to avoid it being overly stressed. This is especially with athletes who run downhill or down trails. This is because extra stress can be placed on the affected knee if the muscles are weak on that side. This is called absorption. Therefore, cross training with a stationary bike, a road bike, elliptical or swimming may be useful to build up the strength without having significant overload with higher impact activities.

4. What is runner’s knee chondromalacia?

Chondromalacia, or varying forms of arthritis, of the patellofemoral joint is often a common cause of runner’s knee. In these circumstances, overuse, genetics or injury may have caused wear and tear of the cartilage on the kneecap joint.  Once the kneecap cartilage starts to wear down, the deeper cartilage is always weaker so the wear out process may accelerate if one does not change their activities or modify their training program. Sometimes, flaps of cartilage can cause a significant pain and an arthroscopy and chondroplasty may be indicated. However, it does not cure the area of chondromalacia/arthritis, so one has to be careful about overloading it again and having the same symptoms develop.

5. What causes runner’s knee when cycling?

The repetitive action of cycling, especially at multiple revolutions per minute, can cause irritation to tissues as they rotate across themselves. Therefore, on the outside of the knee, the iliotibial band and popliteus tendon can become irritated with long distance and heavy cycling. Hard, heavy cycling may also exacerbate some underlying patellofemoral arthritis and cause pain and swelling when one overdoes it too.

6. How does marathon training lead to runner’s knee?

The majority of runner’s knee that occurs with long distance running is due to iliotibial band friction syndrome. This is because the iliotibial band is relatively tight in that athlete and repetitive crossing of the lateral epicondyle causes it to become swollen and  irritated. A proper stretching program may alleviate the symptoms, but also avoiding activities for a period of time that causes the irritation may be indicated. Surgery for iliotibial band friction syndrome is rare and usually only indicated when the iliotibial band is chronically thickened and symptoms do not get better with the above-noted program.

7. How does one differentiate between runner’s knee and a meniscus tear?

Runner’s knee will usually develop after running for a period of time and is usually located in the front part or outside part of the knee where the iliotibial band crosses the joint line. A meniscus tear  most commonly causes pain right at the joint line or at the back of the knee when one squats down.  Flap tears of the meniscus may get caught in the knee while running and could cause the sensation of a pebble in the shoe and this may be an indication for sooner rather than later arthroscopic knee surgery.

8. Can one still run with runner’s knee?

It would be recommended that one try and obtain a diagnosis as to the cause of the runner’s knee if they are going to keep running. If it is simply iliotibial band friction syndrome, which may develop due to certain mileage, cutting down one’s mileage to the point where one doesn’t develop the iliotibial band friction syndrome symptoms may be indicated for a period of time to allow it to quiet down.

9. Can one get runner’s knee from flat feet?

If one has flat feet and tends to over pronate with running, that could put extra stress on their knee which could cause pain in the front of their knee. In these circumstances, having pronation-type shoes or having an orthotic insert may be indicated.

10. Can one have clicking with runner’s knee?

Clicking from runner’s knee could be due to multiple sources. It could be due to scar tissue from a previous surgery, it could be due to some cartilage pieces that are constantly catching and causing friction over each other, or it could be due to some swelling within the knee causing decreased lubrication of the normal structures. Nonpainful clicking is usually due to some swelling and one should try to determine why the swelling is happening in the knee. Painful clicking is a little bit more concerning and it possibly should be checked out sooner rather than later to see if there is a cartilage flap, meniscus tear, or other structure that is catching and causing the clicking.

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