As temperatures continue to rise, more and more runners are getting back outside, training for races and generally stepping their game up after the long (sometimes not sure if it’s really over) winter. There are of course those of you that refuse to let the winter months slow you down but for those of us who hibernate indoors like Yogi with a picnic basket, it’s game time. Unfortunately, game time usually takes a few casualties. Nearly half of all injuries in runners are knee injuries which is why today we’re going to discuss runner’s knee.
What is runner’s knee?
Runner’s knee is often used as an analogous for Patellofemoral Pain Syndrome (PFPS), some will claim they are one in the same while others say that runner’s knee is more of a broad umbrella term. For the purposes of this article, we are discussing PFPS. Patellofemoral Pain Syndrome is an irritation of the tissues between the kneecap (patella) and the femur (your thigh bone). The primary symptom is usually anterior knee pain but in reality can be experienced in various regions of the knee. This discomfort is often made worse by sitting for long periods, like when watching a movie, running (of course) and going up or down stairs (it’ll make you feel old). There are many possible reasons for PFPS including overuse, muscle imbalance/dysfunction, patellar alignment and anatomical differences. The most common reason, especially when it doesn’t get better with rest alone, is misalignment of the patella as it travels through a groove in the femur. This is usually due to imbalance and dysfunction in the muscles and joints. For example, if the Iliotibial Band (ITB) is tight it can pull on the outside part of the kneecap which will result in the kneecap moving through its track closer to the outside and irritating the tissue on that side of the groove. The same is true if an imbalance in the quad muscle exists in which the outside portion is stronger than the inside portion. The problem can also come from a little farther away from the knee. Above the knee, if your hip abductor muscles (primarily the glute medius muscles) aren’t stabilizing correctly, you will run with more hip adduction (your knees will be closer together). This will change the alignment of the patella in the aforementioned femoral groove. Reduced hip internal rotation is another common culprit which will effect proper patellar tracking. Below the knee, over pronation of the foot (or flat feet) results in internal rotation of the tibia (your primary lower leg bone) again changing the alignment of the patella in it’s groove. Reduced ankle dorsiflexion (ability to move your ankle so that the toes move toward your nose) has been linked to PFPS because of how it changes the biomechanics of running.
Runner’s knee treatment
Rest is usually the first step, icing to calm down the irritation is even better. The next step is finding out why it happened in the first place. A thorough evaluation is important to know what to fix so you can get better and back on the Fox River Trail (for you St. Charles locals). You’ll also need to rule out chondromalacia patellae, a condition that is very similar to PFPS but involves more tissue damage. Stretching or foam rolling is important when muscle tightness is involved. The Iliotibial band is a prime candidate for foam rolling. Make sure to check out the video (below) for some instruction on this and be sure not to roll over the knee itself or the hip because this can cause irritation. Muscle strengthening is part of most treatment plans for PFPS to balance any strength/weakness differences in the quadriceps muscle or train the hip abductors to stabilize better. Clamshells are a good exercise to get started on when working on your hip abduction. If imbalance of the quad muscles is your problem, terminal knee extensions may be your solution. The exercise focuses on the inner portion of your quad (the vastus medialis oblique muscle) which is typically the weaker portion. Eventually you’ll want to train the quad muscle as a whole but you’ll need to make sure it’s balanced first. If you’re a flat footed type then you’ll want to look into some shoes that will give you the right support. Most good running shoe stores can get you what you need. If you need a little more support in this department, look into orthotics.
Chiropractic for runner’s knee
A Chiropractor is a good place to start if you are experiencing runner’s knee. They will be able to assess the cause and respond accordingly. At White Oak Family Wellness, treatment for runner’s knee is based on the individual. We create an exercise and stretching plan to address specific weaknesses and dysfunction in addition to correcting any joint restrictions that will limit progress. Joints that are commonly restricted and need manipulation include the ankle (for dorsiflexion) and lumbopelvic (for hip internal rotation) regions. During treatment we find that kinesio taping is a good supplement to the exercises and stretches when muscle imbalances and dysfunction are present. A good example of this is when the inside portion of the quad muscle is weaker than the outside portion. In this example, we would use the tape to help facilitate the inside portion of the quad while using a mechanical correction to resist the lateral deviation of the kneecap as it travels through its track. Not only will this help train the vastus medialis oblique muscle, the mechanical correction will keep the kneecap from compressing the outside of the groove and decrease the irritation and discomfort. This results in quicker recovery time and getting you back to running faster.
By: Phillip Gamble, DC
Chiropractor St. Charles IL
White Oak Family Wellness
405 Illinois Avenue #2b
St. Charles, IL 60174