Runner’s Knee

The human knee is not a very smart joint: when anything unpleasant happens to it, and there are many such things, all it knows how to do is to get irritated and fill up with fluid. One of the more common knee conditions is Runner’s Knee encountered not only by avid runners, but also by people who do other kinds of knee bending: bikers, jumpers, soccer players, and even some walkers not to mention catchers on a baseball team.

Typically there is pain focused around your kneecap (patella), mostly where the thigh bone (femur) meets the patella at the top of your knee. There may be pain in the same place when bending your knee, and especially going downstairs or downhill. Swelling often accompanies the pain, and you may even feel a kind of popping or grinding. This can come on suddenly or gradually over time.

Runner’s Knee is a broad term for those symptoms, but they can arise from different causes.

It could come from falling on your knee or getting whacked by a bat. It could be the irritating effect of over use or over stretching the knee joint It could be even that some foot problems like fallen arches put undue stress on the muscles and tendons.

Another common cause of Runner’s Knee, is misalignment. To understand how misalignment can effect Runner’s Knee, we need to look a bit at how the knee works.

How the Knee Works.

Many of you know words like meniscus as well as cruciate and collateral ligaments which are important parts of the anatomy and functionality of the knee. However, these are not important to the Runner’s Knee condition, and so I shall ignore them for now.

On the front and sides of your femur is a large muscle group that seems to be four separate muscles, but is better thought of as four heads of a single muscle. We call this group the quadriceps (meaning ‘four headed’) or simply the ‘quads.’

At the top they connect to different parts of the femur and the pelvis. At the bottom the quads come together to a single tendon that crosses the patella, top to bottom, attaching to it, and to a bump near the top of your lower leg (tibia which is a flute or pipe).

They The quads are crucial in straightening your knee, bending your hip, and stabilizing your patella. In walking, the quads allow your leg to swing forward for the next step.

The back of the patella is covered with padding material to prevent bone from rubbing on bone as the knee moves although there are no pain nerves on the back of the patella. This is a very precisely organized arrangement where the quads pull in unison, straight up the femur and the patella slides in a groove formed by the knotty bottom end of the femur and the top end of the tibia.

Dislocation.

But suppose there was a pull to one side or the other of this groove that the patella actually begins to shift out of the groove or dislocate; the result would be pain resulting from disturbance of the nerves at the edges of the patella.

Part of the problem is that the femur doesn’t go straight down from the hip joint. Rather it is angled in a bit so that the pull of the quads is putting a sideways pull on the patella. This angle is exaggerated in women whose hips tend to be wider which accounts for Runner’s Knee being about twice as prevalent in women as in men.

Still, the structure of the musculature when balanced is remarkably capable of maintaining the integrity of the patella in its position and function. The problem becomes worse, however, if the quads and other thigh muscles are not balanced. Depending on which muscles are weak the dislocation may be to the outside or inside.

What Can I Do to Treat Runner’s Knee?

Usually, fixing a dislocated patella is pretty easy. Sit down, extend the affected leg, and rest your foot on a pile of cushions. Don’t stretch out as far as you can, but only to a point where your leg is still slightly bent. In this position you or a friend can use your fingers to move the patella back into its natural position.

After this treatment, and for other causes of Runner’s Knee, I recommend the same acronym as for other muscular problems which is RICE: Rest the knee, use an Ice pack on the affected area for 20 minutes two or three times a day until the pain is gone, use a light wrap to Compress the area, and finally keep it Elevated to the extent this is practical. And if they work for you, consider taking an anti-inflammatory like aspirin, naproxen (Aleve) or ibuprofen.

If these simple self-help remedies don’t work in a reasonable period of time then additional professional help may be needed. For example, I have a medical massage treatment that works to help correct and balance the knee structure. For one patient, this treatment eliminated the need for the knee replacement surgery he had scheduled.

With extreme dislocations or if there is severe injury to the tendon or patella itself then medical help may be needed. This may include surgery to remove damaged cartilage or to reposition the patella.

How Can I prevent Runner’s Knee?

Balance in the strength and length of thigh muscles is important in avoiding Runner’s Knee. In addition to the quads, there are the hamstring muscles behind the thigh that bend the leg as well as muscles that rotate the thigh in and out, and allow it to move side to side. In all there are about 18 muscles that control the movement of the thigh and knee.

It may sound like an all day job to keep these strong and long and in balance with one another. It is not quite that daunting, however, and on my website, www.SeacoastMedicalMassage.com, I include a set of simple daily exercises to help achieve that goal.

And please remember to stretch the thigh muscles both before and after running.

A Final Thought.

People ask often why I am such a fan of icing muscular injuries, and the answer is simple: One gets a double benefit from ice: First there is immediate reduction in inflammation and swelling, and second, after about 10 minutes, the ice actually increases circulation to the area with its attendant healing properties; this is call the Hunting Effect.