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Introduction

Runner's Knee

Runner’s knee (patellofemoral pain syndrome) is a dull pain around the front of the knee (patella), where the knee connects with the lower end of the thighbone (femur).

The patella (kneecap) is the moveable bone on the front of the knee. The underside of the patella is covered with articular cartilage, the smooth, slippery covering found on joint surfaces. This covering helps the patella glide in the femoral groove made by the femur.

Runner’s knee occurs when the patella suffers wear and tear. The underlying cartilage begins to degenerate (chondromalacia patella). Wear and tear could be the result of alignment or overuse problems of the patella, or it could be a part of the aging process. This produces pain, weakness, and swelling of the knee joint.

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Causes

Overuse. Bending your knee again and again or doing a lot of high-stress exercises, like lunges and plyometrics (training that uses the way your muscles lengthen and shorten to boost their power), can irritate tissues in and around your kneecap.

A direct hit to the knee. A fall or blow may knock the patella out of place.

Bone structure. Some people are born with a greater than normal angle where the femur and the tibia come together at the knee joint. This may cause the patella to shift outward with greater pressure when the quadriceps muscle contracts, damaging the articular cartilage. People with a shallower-than-normal femoral groove, or a high-riding patella that sits too high on their femur, are also at higher risk of a patellar dislocation.

Muscle imbalances/weakness. Having weak quadriceps or hip abductor muscles could lead to muscle imbalances. This could cause the patella to pull more to one side than the other, putting uneven pressure on the articular cartilage and damaging it. Mistimed quadriceps muscles could also cause the patella to be pulled off track.

Feet problems. Hypermobile feet (when the joints in and around the feet move more than they should, fallen arches (flat feet), or overpronation (feet roll down and inward when you step) may change the way you walk, leading to knee pain.

Symptoms
  • Pain, weakness and instability in and around the kneecap when you are active, or after sitting for a long time with the knees bent.

  • Pain worsens when talking downstairs / downhill

  • Rubbing, grinding, or clicking sound of the kneecap when you bend and straighten your knee

  • Kneecap tender to the touch

  • Swelling around the knee

Diagnosis

The doctor will give you a thorough physical exam. They might also do tests that can give them a closer look inside your joint, like X-rays.

Non-surgical treatments
  • Using the RICE (rest, ice, compression, elevation) method: The RICE method involves resting your knee, icing your knee, wearing an elastic bandage around your knee (compression) and elevating your knee while you’re resting. This helps to reduce pain and swelling.

  • Taking pain relievers: Your healthcare provider may recommend taking pain relievers (non-steroidal anti-inflammatory medications, or NSAIDs) to help reduce pain and swelling in your knee. Acetaminophen can be used as an alternative if you cannot tolerate NSAIDs or are allergic.

  • Wearing a knee brace: Bracing or taping the patella can help you do exercises and activities with less pain. This helps the patella stay in better alignment within the femoral groove, and also improves the pull of the quadriceps muscle so that the patella stays lined up in the groove. Therapists may also design special shoe inserts (orthotics) to improve knee alignment and function of the patella.

  • Doing physical therapy: As the pain and inflammation become controlled, you should focus on improving flexibility, strength, and muscle balance in the knee. Muscle imbalances are commonly treated through stretching and strengthening exercises. These aim to increase the flexibility of the thigh and calf muscles, and to maximize control and strength of the quadriceps muscles.

Surgery