One of the most common injuries or pain in runners is the “runner’s knee”. It is known as patellofemoral syndrome and it can cause pain right behind and around the knee cap. The runner’s knee is usually due to movements that load the knee joint on a flexed position. If our running form or mechanics are off, every time we hit our stride, we add impact to a bent knee as we leap forward. Running stairs and doing squat exercises can cause the same reaction with a leap forward. When running downstairs or down steep hills and we feel some pain or soreness on the knee, those are signs of “runner’s knee”. Luckily, “runner’s knee” isn’t a structural problem, the ligaments and cartilage are fine, the problem comes from muscles function through repeated movements or impact of a run.
Patellofemoral pain is most often due to abnormal mechanics caused by issues up or downstream from the knee, which forces the patella to bump against the femoral groove (the end of the femur). The patella and femoral groove need to run smoothly against one another as they are on top of each other. If they don’t track each other smoothly, and bump against each other, knee pain occurs. What commonly causes this uncomfortable rubbing is muscle weakness and tightness around the legs and core. If some of our leg muscles or core are weak it will affect the smooth tracking of the patella and femoral groove.
What Causes "Runner’s Knee" Pain
1. Weak Hips and Inner Quads
Most runners have strong hip flexors, but often weak gluteus medius. With weak glutes, the femur tends to rotate inward, making the patella strike the edge of the femoral groove, causing pressure and pain. Strengthening the glutes will keep the femur from rotating inward during the weight-baring phase of the running gait.
Basic glute strength exercises with a small resistance band around the thighs.
15 Reps each side/ 3 Sets
Clamshell: Start lying down on one side, propped up on your forearm, shoulder over elbow and hips stacked. Externally rotate top hip lifting top knee toward the top, keep your feet together. Lower back down and repeat.
Perform 15 reps on each side/3 Sets.
Donkey Kick: Start on all fours, shoulders over wrists (inline) and knees right under the hips. Extend one leg up and back, raising the hip height with foot flexed. Press the heel toward the top, keep your back flat and knee points straight down. Feel the glute muscles activated when lifting the leg and pressing the foot up. Lower back to hip height and repeat.
Perform 15 Reps each side/ 3 Sets
Fire Hydrant: Start on all fours, shoulders over wrists and knees under the hips. Keeping the knee bent 90 degrees, lift it out to the side and upward. Make sure you don’t drop into the opposite hip. Lower back down to the floor and repeat.
Perform 15 Reps on each side/ 3 Sets
Straight Leg Raise: Lie down face up with legs straight out. Lift your single leg straight up. Hold for 3-4 seconds, then lower back and repeat. The key is to keep the leg straight to make sure you activate the inner thigh muscle (VMO).
Perform 15 Reps each side/3 Sets
Side Leg Raise: Start lying down on one side, with legs straight out. Lift your top leg straight and hold for 3-4 seconds, then lower back down and repeat.
Perform 15 Reps each side/3 Sets
2. Tight Hamstrings or Hips
We know that weak muscles can cause misalignment in running form that can cause “runner’s knee” pain, and so can tight muscles. Dealing with tight hamstring and hip muscles will limit the range of motion and cause some knee issue.
Basic Stretches to Avoid Hamstring and Hip Tightness
The best recommendation to avoid and reduce tightness is by working on overall flexibility. The best way is to perform stretching and foam rolling sessions every day.
Hamstring- Lie on your back and gently pull one straight leg toward your chest, if it’s too intense, use a yoga strap, resistance band or towel. Hold for 30-60 seconds.
Hips: Perform a runner’s lunge. With one foot in front, place the opposite knee on the ground and press your hips forward, engaging through your back glutes. Hold for 30-60 seconds.
Piriformis: This small muscle under the glute max helps with hip rotation, but if it is too tight it will affect the glutes flexibility and running form.
Perform a half pigeon stretch. Start in downward facing dog position, bring your right foot toward your right wrist, then lower your knee and shin on the ground. Straighten your left leg back- your legs will look like the shape of 7. Align your right knee in line with your right hip, and flex your right foot. Hold for 30-60 seconds each side.
Using a massage ball or tennis ball to roll out the glute muscles, IT Band, quads and hamstrings will also provide many muscle release benefits.
Other factors that can cause runner’s knee issues
Women are more prone to runner’s knee due to wider hips than men. That’s why women have to focus on glutes and quads strength exercises.
Runners dealing with overpronation- flat feet can also affect the knee cap. Strengthening the feet arches is very important to save any “runner’s knee” pain.
Another option to avoid knee pain or injury is to add and switch to different activities like extra yoga sessions or strength workouts on weeks that you feel more muscle discomfort and make sure you take a rest day.
For more intense runner’s knee problems, to get some physio therapy sessions will help with more advanced treatments for knee pain. And taking some glucosamine supplements for joints issues will help strengthening the joints. Consuming turmeric and curcumin will help reduce inflammation. For runners with knee inflammation, to go see a doctor is highly recommended.
Strengthen Your Legs and Core, Save Your Knees, Run Strong!