This week we are continuing with our theme of “running blog posts” and we have, once again, asked Claire Desroches, one of our personal trainers and sports massage therapists, to draw on her specialist knowledge and experience and write a short article on a fairly common running injury called Runners Knee.
In this article Claire simply looks at what causes runners knee and the best ways to treat it.
So, over to Claire :
Back when I was in university, and I was just starting to get properly into fitness and, in particular, running, I used to believe that you weren’t a “real” runner until you had a knee injury. I remember ordering and wearing my first pair of running tights from Up & Running, feeling very sleek and fast… but it was only when I decided I had call to buy a (useless*) knee sleeve that I finally felt like I was a runner.
Too many people dismiss “runner’s knee” as a rite of passage en route to a long-distance event, a necessary evil that will be fixed when you finally get a chance to rest after crossing the finish line. Pain, however, and particularly a persistent niggle, can be a very important early warning sign that something is not quite right.
The term “runner’s knee” can refer to a number of different conditions, but the two most common causes of chronic knee pain in runners are patellofemoral pain syndrome (PFPS) and/or iliotibial band syndrome (ITBS).
Patellofemoral pain syndrome PFPS is felt at the front of the knee, in the patella (kneecap) region – though once inflammation sets in to an area, pain can become more diffuse. The pain is usually dull rather than sharp.
The cause is traditionally thought to be muscular imbalance between the quadriceps muscles, which result in the patella being pulled out of alignment and rubbing against the femur, leading to inflammation and pain.
Iliotibial band syndrome ITBS pain is felt on the lateral side (“outside”) of the knee and usually comes on partway through a training session.
The cause is a tight iliotibial band (ITB) which becomes irritated and inflamed by repetitive motion at the insertion point (where the ITB meets and attaches to the tibia, or shin bone). The ITB often becomes tight when hip muscles (especially piriformis and tensor fascia lata) are tight, which could arise from running technique and/or mechanics at the foot and ankle; if these are weak and unstable, the muscles around the knee and hip will have to work harder and may become tight and overworked.
It can be hard to determine which of these conditions is to blame for knee pain, or which factors caused the condition that resulted in knee pain; for example, do tight muscles result in inefficient biomechanics, or do inefficient biomechanics result in tight muscles? Do issues lower down (i.e. in the foot and ankle) result in issues higher up (e.g. in the hip) or vice versa?
The answer is likely to be multifaceted, and as such any treatment should involve a variety of approaches. Moreover, treatment is likely to involve long-term change to your training and/or recovery habits.
If you suspect you have runner’s knee, or any other knee pain, it is important to get it properly diagnosed early on by a physiotherapist or osteopath. By taking a case history, talking to you about your exercise habits and symptoms, and performing a hands-on assessment your therapist should be able to identify the causes of your pain, and recommend your next steps. In the case of runner’s knee, treatment is likely to involve a combination of the following:
- rest (which could mean total rest, relative rest or cross-training)
- soft tissue massage to release tight muscles and fascia
- manual stretching to lengthen tight muscles
- prescribed stretches to perform in your own time
- exercises to perform on your own or, preferably, with a trainer to supervise
- recommendations about footwear or training technique, if applicable and appropriate
Do not wait until the pain becomes unbearable to seek treatment – when it is just a niggle is the best time to address any issues before they cause inflammation and problems in other areas. If you are in training for an event, regular treatment should be factored into your training plan.
* Those sleeve-type supports do very little except keep your joint warm and remind you there is a problem