Chiswick-Physio BLOG

 

Common Running Knee Injuries and How to Treat Them
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Plantar Fasciitis Stretch

Running is on the rise in the UK.

In 2024, an impressive 22% of the population say they run between 1 to 3 times per week—this includes people who run on roads and trails and people who might run on a treadmill in the gym.

The director of the National Running Show reports that 7 million people in the UK run at least twice a month, with an equal split between men and women. Race organisers have announced that a record-breaking 53,000 runners completed the 44th London Marathon last Sunday, surpassing last year’s figure of 43,965 finishers.

Why is running so beloved in our nation? There are numerous factors at play. Running is inclusive, affordable, and easily accessible, requiring no court reservations or team coordination. People engage in running for various reasons: to shed pounds, enhance fitness, maintain health, surpass personal records, or simply to enjoy solitary contemplation. Moreover, after a run, the surge of feel-good chemicals induces what’s commonly known as a “runner’s high.

It is worth noting that with the rise in popularity of running, there has been an increase in running-related injuries. Approximately 19% of runners have suffered an injury while running. Of all the running injuries, 65% are related to the knee. Additionally, 31% of those who have sustained a running injury have experienced it for over a year.

Common knee injuries due to running

Among runners, the knee stands out as the joint most frequently prone to injury, with potential damage ranging from fractures and dislocations to sprains and tears in both the internal and external structures. Structures of the knee vulnerable to running-related injuries include:

Articular cartilage is smooth, protective tissue covering the ends of the shin and thigh bones and the back of the knee cap.

Ligaments are tough bands of fibrous tissue that connect bones and stabilise joints. In the knee, there are four main ligaments: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), lateral collateral ligament (LCL), and medial collateral ligament (MCL).

Knee menisci are two C-shaped wedges of cartilage that cushion and help stabilise the knee.

Tendons connect your muscles to the bone.

At Chiswick-Physio, the knee is in the top 3 of the most common injury sites, along with the shoulder and back. Of the knee injuries we see at Chiswick-Physio, the nine most common are:

  1. Runners Knee (PFPS)
  2. ACL injuries
  3. Iliotibial Band Syndrome (ITBS)
  4. Patella Tendinitis (Tendinopathy)
  5. Chondromalacia Patella (CMP)
  6. Kneecap Bursitis (Prepatellar Bursitis)
  7. Meniscus Tear
  8. Knee stress fracture
  9. Patella Subluxation

Runners Knee (Patellofemoral Pain Syndrome)

“Runner’s knee”, medically known as patellofemoral pain syndrome, is a common knee condition that affects runners. It is characterised by pain around or behind the kneecap (patella). The condition is believed to be caused by an imbalance in the muscles supporting the knee and mechanical errors resulting in poor knee tracking. Symptoms may also occur after squatting or prolonged sitting.

If you believe that you are suffering from patellofemoral pain syndrome, which is causing hindrance in your daily activities or running, it is advisable to consult a physiotherapist at the earliest. Continuing to run may aggravate your symptoms, so it’s better to seek medical attention as soon as possible. The treatment should primarily focus on correcting imbalances in the pelvis and leg through a strengthening program. Exercises typically involve strengthening the glutes, hamstring, abdominals and calf.

ACL injuries

An ACL injury occurs when the ligament in the knee is torn or overstretched, leading to instability and impaired function. This type of injury often results from sudden stops, changes in direction, or direct impact.

The initial symptoms of an ACL injury usually involve a popping sensation in the knee during the time of injury, followed by considerable swelling and pain within the joint. Instability and difficulty with weight-bearing or fully extending the knee are also common.

It is important to know that surgery is not always necessary. Whether you opt for a non-surgical or surgical approach, it is highly recommended that you follow a structured rehabilitation program under the guidance of an experienced physiotherapist. Before returning to pre-injury activity levels, you should maintain consistency with your rehabilitation for at least 12 months.

Iliotibial Band Syndrome (ITBS)

Iliotibial Band Syndrome occurs when the iliotibial band becomes irritated or swollen due to compression against the lower end of the thigh bone at the knee joint. This compression leads to friction, inflammation, and pain.

ITB Syndrome is often caused by poor biomechanics, tight hip structures, weak gluteal, core or quadriceps muscles, or activity in improper footwear.

At Chiswick-Physio, we frequently address ITB syndrome, commonly observed during endurance event training such as the London Marathon or Ride London, when activity levels are increased too quickly. Our treatment approach includes modifying your training, strengthening exercises, stretching routines, manual therapy, pain management, and biomechanical assessment tailored to your needs.

Patella Tendonitis (Tendinopathy)

Patellar tendinopathy, also known as jumper’s knee, is a condition that causes pain in the front tendon of the knee, just below the kneecap. Symptoms of this condition include stiffness, weakness, and gradual onset of pain, often worsened during running or other physical activities. Training intensity and biomechanics are some factors that can contribute to the development of this condition.

Chiswick-Physio has become well-known among its clients and peers for offering an exceptional, highly specialised clinic that caters to those experiencing tendon pain, particularly those who have not seen improvement through conservative care. Your physiotherapist will create a customised program based on your personal profile, including education, pain management, loading exercises, biomechanical re-education, range-of-motion exercises, manual therapy, and muscle strengthening. This program is designed to optimise your recovery and prevent future occurrences of tendon pain.

Chondromalacia Patella (CMP)

Chondromalacia patellae results from damage to the articular cartilage of the knee. It is a chronic condition that causes your kneecap cartilage to soften and break down, resulting in pain and inflammation. Knee overuse, alignment problems, injury, or ageing are the causes. Symptoms like knee pain and grinding sensations often arise from overuse or improper alignment, especially during running or after prolonged sitting.

Treatment can include patella stabilising braces, physical therapy for hip, pelvis and lower limb strengthening, orthotics that decrease foot pronation, and nonsteroidal anti-inflammatory medication. Platelet-rich plasma (PRP) is sometimes advocated, but it is not the standard of care.

Kneecap Bursitis (Prepatellar Bursitis)

Prepatellar bursitis is the inflammation of the bursa in front of the patella. Bursae are fluid-filled buffers between the skin and underlying tendons or bones to mitigate friction. The prepatellar bursa, a vulnerable point in the body, is frequently impacted by repetitive kneeling.

It can be caused by repetitive friction in the area, muscle tightness, or a sudden injury to the knee.

If the bursa isn’t infected, nonsurgical treatment for bursitis includes modifying activities, icing regularly, elevating the leg, and taking NSAIDs like naproxen or ibuprofen. Following a physiotherapy assessment, strengthening should be required to reduce the load on the knee and bursa. If needed, a specialist may perform aspiration and corticosteroid injections.

Meniscus tear

Isolated meniscal tears occur when your knee twists when your foot is on the ground. It can also occur through direct impact in contact sports and in older athletes through gradual degeneration. Signs and symptoms of a knee meniscal tear include pain, swelling, stiffness, catching or locking sensation in the knee, difficulty straightening the knee fully, and instability, especially during twisting or pivoting movements.

Treatment for meniscal tears depends on factors like tear type, size, location, and patient activity level. Options include rest, ice, physical therapy, and, in some cases, surgery like arthroscopic partial meniscectomy or meniscal repair. Current research indicates the same outcome at 12 months, whether you have a surgical or non-surgical approach.

Whether or not you have surgery, the main treatment pathway is the same: a progressive strengthening program over four to six months.

Knee stress fracture

A knee stress fracture (a hairline fracture) is an injury in which a small crack develops in your kneecap (patella). Your patella acts as a shield, protecting your knee joint. While rare, stress fractures of the knee seem to have a higher occurrence in athletes.

Knee stress fractures are typically caused by sudden increases in running activity, direct impacts, or falls. Athletes whose sport perform repetitive stress related to running or jumping are more likely to develop knee fractures. Common symptoms of knee stress fractures may include pain, swelling, pinpoint tenderness, and worsening discomfort during activity. Additionally, those suffering from knee fractures may experience an inability to bear weight, wake up at night, or bruising. Risk factors such as obesity or poor footwear can exacerbate the condition.

Patella (Knee cap) Subluxation

The kneecap can sometimes move from its usual position, partially or completely, causing subluxation or dislocation. This can damage the surrounding tissues by stretching or tearing them. It is usually caused by a sudden blow or change in direction when placing the foot on the ground.

Patella instability occurs when the kneecap is displaced from its groove, usually due to repeated dislocations or traumatic incidents. Various factors can contribute to patella instability, including pelvic width, shallow groove, gait abnormalities, or misaligned patella. Symptoms of patella instability include pain, swelling, stiffness, creaking sounds, and sensations of slipping or buckling in the knee.

Treatment for an unstable patella aims to prevent dislocation. Physiotherapy focuses on strengthening the quadriceps and the hip abductor/flexor to realign the patellar pull. Bracing or taping may aid, but it should not be used long-term. Surgery is a last resort, considered if conservative methods fail or if there is severe misalignment or recurrent dislocations.

When to seek treatment

It is common for your knees to feel achy after a run if you increase your mileage, as you may overload them. Rather than getting a specific injury, the joint and some structures in and around it may become irritated because they are being asked to work harder than what they currently have the strength for or they are not given enough time to recover. It is important not to ignore these signs if they persist and continue to ramp up the miles, as they may eventually develop into an injury.

If knee symptoms do not settle, you develop pain, or you are aware of swelling or giving way, it is important to seek advice from a physiotherapist. Prompt intervention will allow the physiotherapist to diagnose the problem and indicate what will make it better and what will make it worse. This can prevent minor issues from escalating into chronic conditions, ensuring a quicker return to pain-free running.

Diagnosing your knee injury

It is essential to receive an accurate diagnosis of your problem to ensure you are prescribed the best and most effective treatment plan. Physiotherapists are highly skilled diagnosticians who perform a comprehensive subjective and clinical assessment.

During your initial appointment, your Physiotherapist will ask questions about your past health, exercise regime, and symptoms to help them better understand what is likely to have caused the problem.

Following questioning, the physiotherapist will conduct clinical tests to confirm their diagnosis. These may include:

  • Assessing the range of motion of your knee joint,
  • Assessing the strength of your lower leg muscles using a handheld dynamometer to gauge leg muscle strength discrepancies
  • Assessing muscle length and flexibility of calves, quadriceps, glutes and hamstrings
  • Watching you move your knee and how you perform activities such as squatting, hopping, jumping, and running.
  • We will also check other body regions, such as your hips, feet, and lower back if necessary. This will help determine if other areas contribute to the problem and require treatment to improve your condition.

Depending on your condition, they may suggest a 3D running analysis to pinpoint biomechanical issues.

If deemed relevant to your injury, we may refer you for further investigation and an MRI, ultrasound scan, or MRI. These are to confirm our thoughts and are not used as the main diagnostic tests.

Common treatments for knee injury

Chiswick-Physio has earned an excellent reputation from patients and colleagues for delivering exceptional, specialised care addressing knee pain, especially in cases resistant to conservative treatment. Our clientele spans elite athletes to recreational runners and individuals with more sedentary lifestyles. We’re entrusted by globally recognised orthopaedic surgeons and sports medicine consultants to provide top-tier care to our patients.

Your dedicated physiotherapist at Chiswick-Physio will craft a personalised regimen tailored to your unique needs. This will often include the following elements:

  • Relative rest: Advising on activity modification and rest to alleviate pain and support proper healing of your knee injury.
  • Patient education: Ensuring you understand your condition and the steps needed for optimal recovery.
  • Pain management: Utilising knee taping, supports, walking aids and ice application to relieve load and diminish discomfort.
  • Biomechanical and movement re-education: Guiding proper squatting, lunging, running, or jumping techniques.
  • Range-of-movement exercises: Teaching self-stretching techniques to reduce tension and restore joint mobility.
  • Manual therapy: Employing massage or soft tissue release to enhance movement and reduce muscle stiffness.
  • Muscle strength: Design a comprehensive resistance program to address lower limb muscle imbalances, aid recovery, and avert reinjury. A strengthening programme is key to your recovery, requiring dedication and consistency.
  • Shockwave therapy for tendon issues: Shockwave therapy supplements your rehabilitation regimen, offering substantial pain reduction and hastening recovery from tendon-related injuries of the knee.
  • Functional and sports-specific training: Gradually reintroducing demanding activities once pain, strength, and range of motion improve, facilitating a safe return to your beloved sport.

During your care journey with Chiswick-Physio, we’ll consistently assess your advancement through objective evaluations. Revisiting your objectives regularly ensures active participation and ongoing support throughout rehabilitation. Our commitment lies in restoring you to full activity and functionality, supported by our proficient team of practitioners dedicated to realising your goals.

FAQs

How do I stop my knees from hurting when I run?

To alleviate knee pain while running, wear appropriate footwear, maintain a balanced exercise routine, increase intensity gradually, and include strength and flexibility exercises. Consult a physiotherapist if you have any underlying issues, and listen to your body’s signals to avoid overexertion.

Is it OK to run with knee pain?

Running with knee pain is not advisable as it can worsen the condition. It’s crucial to identify the cause of the pain and address it with appropriate treatment. Continuing to run may lead to further injury and prolonged recovery time.

How do you treat a runner's knee pain?

Several treatment options are available if you’re experiencing knee pain from running. You may need to rest or adjust your activity levels and use ice, compression, and elevation (RICE) to reduce your symptoms. Additionally, exercises that strengthen your trunk, hips, pelvis, and lower limbs can be helpful. Physiotherapy can help identify and address any underlying biomechanical issues, while a structured strengthening and mobility program, followed by a gradual return to running, can help prevent future occurrences.

Does a runner's knee go away?

Runner’s knee can be treated effectively with proper care and rehabilitation. Recovery can be aided through rest or modification of activity, education on the condition, strengthening exercises, and addressing contributing factors like biomechanical issues. However, it’s important to avoid ignoring symptoms or continuing to run through pain as it may worsen the condition and lead to prolonged discomfort or recurrence.

How do I strengthen my knees for running?

Focus on exercises that target your glutes, quadriceps, hamstrings, abs, and calves, such as squats, lunges, and calf raises. Incorporate leg presses and planks to support joint stability. Gradually increase resistance and pay attention to proper form to build strength.

What exercises should you avoid with knee pain?

If you are experiencing knee pain, avoiding high-impact activities such as running or jumping is advisable. Additionally, it is best to avoid exercises that put excessive pressure on the knees, such as deep squats or lunges. It is important to avoid activities that worsen the pain and opt for low-impact exercises like swimming or cycling until the symptoms improve.

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