Runner’s Knee – What It Is, and What to Do About It

The Runner’s Knee diagnosis is one that includes a number of possible conditions and tends to get used a lot when it comes to knee pain in runners. In a general sense, Runner’s Knee is typically referred to when someone has pain located on the front of the knee. Runner’s Knee is more of a descriptor of location of pain rather than an actual diagnosis.

To give a little understanding, a number of diagnoses fall under this heading of Runner’s Knee.

  • Patellofemoral misalignment or patellofemoral syndrome
  • Chondromalacia patella
  • IT band syndrome
  • Patellar tendinitis

Patellofemoral misalignment/syndrome basically means the kneecap (patella) is not tracking properly on the long bone of the thigh (femur). This can cause a grinding sensation and pain.

Chondromalacia patella is a softening of the cartilage under the kneecap. It sounds horrible when it is described that way, but it is not as bad as it sounds and is easily treated.

IT band syndrome is pain along the outside of the thigh or knee. When it is involved in Runner’s Knee, the pain is located more on the outside and occasional front of the knee.

Patellar tendinitis is pain in the tendon from the quadriceps that crosses over the knee and attaches to the long bone of the lower leg (tibia). The pain is normally just below the kneecap.

What causes this pain?

Conveniently, because of the structure and mechanics of the knee, all of these are frequently caused by similar issues and therefore are treated in a similar way.

Mechanically speaking, the knee is a hinge joint. Not much can go wrong at the knee by its own doing. Unless you had a specific injury to the knee, such as twisting it, getting hit on the knee from the side, or falling on the knee, the pain and injuries you experience in the knee are symptoms of something else not working right above or below the knee.

Ultimately, it comes down to your running technique. It means that when you land, you are lacking good control and stability through your foot/ankle, your hip, and/or your low back, causing increased forces through the knee and/or a torsional motion at the knee. Over time, the structures at the knee get irritated, resulting in pain.

So now you know the cause.  Let’s see about correcting it!

First and foremost, you need to stop overstriding. Overstriding causes you to land with your foot way out in front of you and on your heel. In that position, there is no way your leg and body can have good control and stability. If you land with your foot more underneath your body, you immediately have more control and stability through your leg when your foot hits the ground.

Do this test: put your foot out in front of you with your heel on the ground and attempt to stand on that leg in that position. I bet you can’t do it! Now, put the leg underneath you and attempt to stand. Is it easier? You bet!

If you are landing every step in the position where you can’t even stand, how do you expect your leg to be able to control itself when running, especially with increased forces through the leg? You can’t!

Start working on shortening your stride. You can begin to do this by increasing your cadence. The ideal cadence is about 180 steps per minute. Not only will this force you to land quicker, which will naturally shorten your stride and get your foot closer to underneath your body, a cadence of 180 has also been found to be where our muscles and tendons function most efficiently when running. Greater efficiency = less energy used = longer and faster running!

The easiest way to begin that transition is by getting metronome app for your phone or use Spotify or Google to find songs with 180 beats per minute.  With that said, you want to make sure your cadence increases in a smart manner. If you are running at 150 steps per minute currently, start by a smaller increase in the range of 160-165 steps per minute. Once comfortable there, increase a bit more. The transition will be easier for your body if you make the smaller jumps rather than one big one.

The other two factors that play a huge role in your running mechanics are strength in the foot and the hip as well as your balance.  I see a lot of runners who can’t stand on a single leg for any period of time or can’t jump and land on one leg with good control. As a runner, you are only on one leg at a time.  If you don’t have good balance and control just standing or just landing from a small jump, it only makes sense that you will not have good control through your leg when running, especially as the miles add up.

Along with increasing your cadence, start working on your balance, your foot strength, and your hip strength. You will notice a significant improvement in your knee pain once you start addressing these issues. As a side benefit, you will likely notice you are running faster and with less energy being used.

Happy running!

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