Is Running a Pain in the Knee? 

 July 5, 2019

By  Dr. Michael J Egan

If you are experiencing knee pain while running chances are you are experiencing a very common knee condition known as "runner's knee," also known as Patellofemoral Pain Syndrome (PFPS).   With its high prevalence among runners PFPS is often characterized by sharp knee pain, tenderness or stiffness in the front or around the patella (kneecap) and originates from the back of the kneecap coming in contact with the femur (thigh bone) due to poor tracking.

Other symptoms may include:

  • Pain on bending at the knee or doing squats/lunges
  • Pain toward the back of the knee
  • Cracking sensations
  • Feeling of the knee's giving out
  • Often going up or down steps, hills, and uneven terrain can aggravate PFPS.

Often the pain can start gradually or as the result of an event such as a sudden increase in training intensity.  You may begin to experience some swelling around the kneecap and eventually find it very difficult to even run a few steps without pain.

What Causes Runner's Knee?

Patellafemoral pain syndrome is usually due to movements that load the knee joint on a flexed position. This problem is most often a result of abnormal mechanics caused by problems up or downstream from the knee, forcing the patella to bump against the femoral groove or not track properly. Therefore, if your posture, lower limb joints or running mechanics are off, any time you hit your stride, you add impact to a bent knee as you take that leap forward, and this is what can cause the pain.  but it is linked to:

  • Overuse of the knee: running, jumping or activities that put a repetitive strain on the knee joint (i.e. throwing a javelin in track and field), which can lead to pain in the patella.
  • Muscle imbalance: When certain muscles, such as those around the hip and knee, are weak, they fail to keep adjacent body parts, including the kneecap, properly aligned. This may eventually lead to injury.
  • Trauma: Injury to the kneecap, or knee surgery, may increase the risk of experiencing patellofemoral pain syndrome.

Normally the patella glides up and down the femoral grove smoothly. When muscles and biomechanics learn and remember to function in an imbalanced way – the kneecap can't track as well.   One analogy to compare this to is like a train car: the kneecap is like a train on the femoral groove railroad track. And when the train and track don't run smoothly against one another, inflammation and pain occur.

Assessing Runner's Knee

The good news: Runner's knee isn't a structural problem per sae, but more of a functional problem. This means your ligaments and cartilage are OK. However, your muscles, tendons and knee joint mechanics become stressed and dysfunctional through your runs from the repeated imbalanced movement kinematics which is often the major culprit of your knee pain. Therefore, getting to the root cause of your functional and kinematic chain problems is important for sustained results.

When assessing knee pain, particularly PFPS, at Motion Health Centre I find it very helpful to perform a complete and detailed examination, including a full health history.   This includes both specific knee tests and a comprehensive look at the whole lower limb on both sides, as well as posture, spine and pelvis function; such as:

The Motion Health Centre Lower Limb Regional and Spine Exam covers the following when examining all knee and lower limb complaints:

  • Knee orthopedic tests; such as the patella grind test
  • Active and Passive Range of Motion of the Knee
  • A detailed map of muscle imbalances assessing both short and weak muscles of the whole lower limb (hips, knees and ankle and feet) and spine and pelvis.
  • A comprehensive spine and pelvis function exam
  • Functional tests such as squats or lunges
  • Posture assessment
  • Current running regime
  • Any relevant imaging such as X-rays, MRI's, etc. if required
  • Review of running shoes

It is my experience in practice after regularly examining many patients with various painful knee conditions, such as knee osteoarthritis and meniscal tears (topics of future posts), that PFPS can often be a significant precursor to suffering from these other more problematic knee conditions.  Considering the functional movement of the hip in knee and running conditions is very important as they each are just the other end of the femur bone (read more about this here) Therefore, getting to the root cause of your functional and kinematic chain problems sooner than later can be very helpful.

If you are suffering from knee pain and would like to learn more how we can help?

Contact our team today!

Dr. Michael J Egan

Dr. Michael J Egan is the Director of Motion Health Centre and Principal Sports Chiropractor, Registered Trigenics Practitioner and Provider of the Frozen Shoulder Procedure.

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