By William Brightman DC, MS, MEd
“Runner’s knee” is a common term given to the type of athlete it impacts the most- runners. But people who develop runner’s knees are not always runners. It is a repetitive stress injury and can be brought on by any action done repeatedly over an extended period of time. Jumping, squatting, hiking, climbing stairs, and of course running are all causes of runner’s knee. There are other factors beyond the typical repetitive stress contributing to runner’s knee. This article will look at some of the other factors that contribute to runner’s knee and how it is managed conservatively with therapeutic exercise, physical therapy, and chiropractic care.
The medical name for runner’s knee is patellofemoral syndrome. Symptoms of patellofemoral syndrome are pain around the knee that can be described as a dull throbbing ache that is caused from excessive activity but can be felt at rest or while exercising.
Additional symptoms may be tenderness to the touch and clicking or popping of the tendons that cross the joint. When examined more closely the symptoms and diagnosis of “runner’s knee” goes beyond running. It is important to look at alignment, joint function, and muscle weaknesses in the lower extremity. Each of these may contribute to patellofemoral syndrome. The foot and hips are two regions that may influence the knee. Moreover, the muscles that cross the hips and knees have a direct impact on patellofemoral syndrome. Especially when they are weak or imbalanced. This is why it is critical to strengthen and bring these muscles into balance to correct the problem. Ice, anti-inflammatories, and rest are nice to alleviate symptoms but corrections require a program of guided treatment and therapeutic exercise in order to get more lasting results.
Knee anatomy from the front and back
Let’s start with the foot joint. The foot is amazingly complex and is composed of 26 bones and 33 joints. Misalignments in these bones can contribute to tracking problems of the knee. Overpronation of the foot has been closely associated with knee and hip problems as well as low back issues. Oftentimes, one “keystone” bone (navicular bone) may be falling further than the other bones and this may contribute to excessive overpronation- and instability to foot, ankle, and knee. This happens slowly and insidiously and the individual may not even know it is going on.
When the “keystone” bone (navicular bone) falls the result is overpronation-
this will contribute to runner’s knee.
Adjustments to the bones of the feet combined with individual specific exercises and orthotics will help to correct the foot problem that is impacting the knee.
Another structural problem that may contribute to runner’s knee is from the hips. Hip flexor muscles cross the hip joint and over time they can become shortened and contribute to hip and pelvic misalignments and joint restrictions. This in turn will shorten a major muscle called the rectus femoris which crosses both the hip and knee joint. When this muscle is shortened it will pull on the patella contributing to runners' knee. The treatment requires manipulation to the hip and pelvic (sacroiliac) joints and a program that stretches and strengthens the rectus femoris muscle.
Muscles that cross the hips and knees may be imbalanced over time and should be addressed to bring up any weaknesses. Once weaknesses are addressed and strengthened then knee pain will often subside and heal. One treatment (i.e. ice & rest), is not sufficient in managing runner’s knee. It is easy to tell someone not to run but our job is to get them running safely, in the right shoes, and properly adjusted and strengthened. The knowledge the patient has is empowering!
The individual with runner’s knee should make sure that they have proper running shoes (i.e. brooks or asics) and possibly orthotics (we recommend sole support orthotics) for further support to the arch. It is recommended to increase activities slowly, stretch before and after running and pay attention to good running mechanics (get video analysis and read articles on running biomechanics). If the runner is overweight, then a weight management program combined with brisk walking may be advised before running. These tips combined with corrective exercises and sports chiropractic care will yield fantastic results in the treatment and management of patellofemoral syndrome or runner’s knee.
Below are some basic exercises that are helpful for Runner’s knee. Isolation exercises combined with stabilization exercises are best for condition.
Terminal knee extension with foot rotated out and flexed to activate inner quadriceps. This muscle (vastus medialis) becomes weakened with repetitive stress and the patella tracks laterally- this exercise is a good place to start with a runner's knee.
Hip abduction and flexion performed slowly to strengthen abductors and flexors
Glute bridge for stabilization of pelvis Stretching the hip flexor (rectus femoris)
Lateral band shuffle to activate gluteus medius(important to stabilize pelvis from side)
William Brightman DC, MS, MEd
Private Practice Mahopac, NY
Dr. William Brightman has been a practicing chiropractic physician since 1998 and has been in health promotions since 1989. He currently has a successful private practice in Mahopac, NY, where he specializes in the diagnosis and treatment of joint and muscle pain.