There are a lot of structures around the knee that can get injured and painful with running and athletic activities.
5 most common running related knee injuries
1. Anterior Knee Pain or Runner’s Knee (Patellofemoral Pain Syndrome) / Chondromalacia Patellae
2. Jumpers knee (patellar tendinopathy / tendinosis / tendonitis)
3. Iliotibial Band Syndrome (ITBS)
4. Inside knee pain / pes anserine Tendonitis / Bursitis
5. Quadriceps Tendonitis / Tendinopathy / Tendinosis / Quadriceps Tendon Strain and Suprapatellar / Quadriceps Bursitis
What’s the cause of knee pain in runners?
There isn’t a simple or single answer to this problem…the biomechanics and proper functioning of the whole system has to be taken into account.
Load Threshold: The ability of the tissues to handle repetitive loading over a given period of time. Basically how much load, activity, movement, etc. can a specific tissue handle before it starts to fail. This principles applies to all tissues in the body.
If my knee can only handle 4 miles of running and I continue to push past the limit without allowing adequate rest time…it can result in breakdown of the tissues and injury. Once you have the injury, the tissue is in a weakened state making it much harder to tolerate even basic day to day activities which were easy and pain free.
The injured tissue’s threshold for tolerating activity changes. At this stage, if you continue to do things which further irritate the symptoms they often become chronic.
Anatomy and Biomechanics: the anatomy and biomechanics of the whole chain…from the foot up to the pelvis and spine have to be taken into account when trying to treat a runner with knee pain.
For example, if you are missing ankle flexibility you are bound to change the way your stand, walk and run. Resulting in altered mechanics up the chain and causing an imbalance and more stress on the knee and surrounding tissues.
Here are some common causes of running knee injuries
Weak glutes – specially gluteus maximus and gluteus medius.
Weak Core stability – poor strength or control of the deep trunk stabilizers like transversus abdominis, multifidii, pelvic floor muscles and diaphragm.
Poor foot stability – poor strength and motor control of the foot muscles like flexor hallucis brevis, flexor hallucis longus, etc.
Missing big toe extension range of motion (bending big toe up towards the shin)
Missing ankle dorsiflexion range of motion (bending ankle/foot up towards shin)
A more specific list of problems contributing to knee pain and running
1. Overuse or repetitive trauma to the kneecap and surrounding tissues. Running on hard surfaces like pavement, downhill running, running long distances, etc. can all result in excessive load and stress on the knee and surrounding structures. Running every day and not mixing up your training.
2. Flat feet or excessive foot pronation though not a primary reason can cause increased load on an already overstressed and irritated tissue. The thinking goes…if your foot is flat, it will cause a biomechanics change up the chain causing the lower leg tibia to rotate medially (inwards) resulting in a change in alignment of the knee cap and causing anterior knee or patellofemoral pain.
This theory doesn’t hold true for everyone and can’t be accepted as a reason for anterior knee pain problem by itself. The studies show no consistent relationship between patellofemoral pain and excessive pronation. Though some people tend to benefit from the use of foot orthotics to support the arch, specially in the acute stage of the injury.
3. Tight hip capsule resulting in more hip internal rotation can change the alignment between the hip and knee…causing problems at the knee. Also, hip flexor tightness is a major factor in a lot of running knee pain issues. Hip flexor stretch is a must for most runners.
4. The infamous “Q Angle” – Should you be afraid of a larger “Q Angle”?
This is the angle created between the pelvis and hip.
Wide hips can cause an increased Q angle resulting in “knocked knees”. This can affect the alignment of the pelvis, hip and knees, possibly resulting in more stress on the patellofemoral joint (PFJ), Ilitibial Band (ITB) and the inner knee.
A larger “Q Angle” is more common in women, owing to the wider hips.
The popular theory is that a larger Q angle results in poor tracking of the knee cap causing micro trauma to the cartilage under the knee cap.
Well lets just that the larger Q angle combined with other risk factors might contribute to PFJ pain…but by itself research has shown that it’s not related to development of PFJ pain.
5. Weak and tight quadriceps muscles can also result in increase load on the patellofemoral joint.
6. Tight and weak hamstrings can limit knee range of motion and affect stability of the joint.
7. Patellofemoral joint stiffness and myofascial restrictions of tissues surrounding the patella or kneecap.
8. Weak hip muscles: gluteus medius and gluteus maximus weakness can cause poor stability at the pelvis, hip and down the chain.
9. Weak core muscles will result in a weak base which can often lead to mechanical problems down the chain resulting more stress and knee pain.
10. Poor diet and lack of nutrition can also predispose runners to injuries. Often also leads to poor recovery and slowing down of healing time.
11. Lack of rest and inadequate downtime can prevent the body from recovering from post training wear and tear.
12. Not varying training or running routines can also cause overuse trauma and often pain. Very important to incorporate cross fit training, strength training, Yoga and other forms of exercises to restore balance and prevent injuries. It’s important to challenge the neuro-muscular system with a variety of activities so it can handle higher stresses and unforeseen situations.
It’s very important to treat above and below the chain, making sure to strengthen all the muscles and improving mobility from head to toe.
Additional Posts You Might Find Helpful…