Knee

Runner’s Knee: A Comprehensive Guide

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Medically reviewed by Dr Ong Kee Leong, MBBS (Singapore), MMed (Ortho), FRCSEd (Ortho), Senior Consultant
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Running subjects the knee joints to repeated movements that may cause substantial strain over time. Patellofemoral pain syndrome—commonly known as runner’s knee—affects numerous athletes and fitness enthusiasts. This comprehensive guide examines the condition in depth, providing detailed information on its causes, symptoms, diagnosis, treatment options, and preventative techniques to help runners stay active while minimising knee discomfort.

What is Runner’s Knee?

Runner’s knee develops when the kneecap (patella) undergoes undue or incorrect pressure while tracking along the groove in the thigh bone (femur). This misalignment generates pain surrounding or behind the kneecap, notably during activities like running, ascending stairs, or performing squats. The condition may emerge progressively or result from overuse or improper biomechanics.

Recognising Symptoms and Signs

The symptoms of runner’s knee can vary, but generally include the following:

Kneecap Pain

A persistent ache or soreness appears beneath or around the patella, especially during activities that require repeated knee flexion, such as running, squatting or climbing stairs.

Grinding Sensations

The knee may produce grinding, clicking, or popping noises when flexing or extending the leg.

Post-Sitting Discomfort

Discomfort tends to intensify following prolonged periods of sitting with bent knees, commonly termed the ‘theatre sign’.

Mild Swelling

Slight swelling or puffiness may occur around the kneecap, especially after physical exertion.

Contributing Causes of Runner’s Knee

Several factors can influence the development of runner’s knee, including:

Biomechanical Factors

Flat feet, high arches, knock knees, or other alignment variations may disrupt proper patellar tracking.

Training Progression Errors

Sudden increases in running distance, pace, or intensity can overwhelm knee structures, resulting in inflammation or irritation.

Muscle Imbalances

Weakness in the hip abductors, gluteal muscles, or quadriceps, coupled with tight hamstrings or calves, can compromise knee alignment and stability.

Footwear Considerations

Worn-out or unsuitable running shoes may fail to distribute impact properly, increasing stress on the knee joints.

Diagnostic Approaches for Runner’s Knee

An accurate diagnosis of runner’s knee is necessary for effective treatment. A variety of methods are used to assess the condition, including:

Physical Examination

A thorough assessment of knee alignment, flexibility, and movement is conducted. Strength and stability tests are performed to identify weaknesses in the surrounding muscles while observing pain patterns during movements such as squatting or stepping.

Medical History

An in-depth examination of the patient’s running patterns, past injuries, and symptom progression offers important information about the contributing factors. Enquiries frequently focus on any previous knee problems or recent training modifications.

Imaging Studies

X-rays or MRI scans may be recommended to rule out alternative conditions, such as ligament tears or cartilage damage. These images also assist in assessing patellar alignment and overall joint health.

Effective Treatment Strategies

Most instances of runner’s knee can be managed effectively through conservative methods.

Rest and Activity Modification

Temporarily reducing or modifying high-impact activities allows for knee healing. Low-impact alternatives such as swimming or cycling may be appropriate during recovery. The rest period is tailored based on symptom severity.

Targeted Strengthening Exercises

Specific exercises strengthen the quadriceps, hip stabilisers, and core muscles. These programmes focus on enhancing muscular coordination, improving flexibility, and rectifying biomechanical imbalances to decrease stress on the patella.

Ice Therapy

Applying a cold compress or ice pack to the knee following activity helps decrease swelling and relieve discomfort. This can be implemented several times daily for 15–20 minutes.

Pain Management

Over-the-counter anti-inflammatory medications, such as ibuprofen, may be recommended to address acute pain and inflammation during the initial treatment phase.

Prevention Strategies for Runners

Preventing runner’s knee requires adopting practices that reduce knee stress while maintaining proper alignment and muscular balance. The key strategies include:

Gradual Training Progression

Build mileage gradually to allow knees and surrounding muscles to adapt properly. A recommended guideline is to increase weekly mileage by no more than 10%.

Regular Strength Training

Incorporate exercises targeting the hip, quadriceps, and core muscles into your routine. This promotes better joint alignment and stability, reducing the likelihood of knee issues.

Proper Footwear Rotation

Replace running shoes if they display signs of wear. Ensure shoes provide adequate cushioning and arch support suited to your foot type.

Surface Variation

Running on different surfaces, such as trails, tracks, and pavement, helps distribute stress more evenly across the joints.

By prioritising these preventative strategies, runners can maintain their activity levels while lowering their chances of developing knee pain.

When Medical Attention Is Recommended

If home remedies do not alleviate symptoms of runner’s knee, professional medical attention may be necessary. Persistent pain that intensifies over time, substantial or increasing swelling, and difficulty walking or bearing weight on the affected leg are all indications to consult a healthcare provider.

Additionally, symptoms such as the knee unexpectedly giving way or locking during movement may signify underlying structural issues that require further evaluation. Seeking timely medical advice not only ensures an accurate diagnosis but also helps prevent potential complications that could extend recovery or necessitate more intensive treatments.

Conclusion

Runner’s knee represents a common but manageable condition affecting athletes and active individuals. By comprehending its causes and symptoms, implementing effective treatment approaches, and practising preventative measures, most people can recover fully and resume their running routines without long-term restrictions. Addressing the issue promptly and consistently is fundamental to ensuring ongoing knee health.

Schedule a consultation today for a professional assessment and a customised treatment plan to address your running-related knee concerns.

"Moving your body the way nature intended is a freedom not well appreciated until it is lost. We are passionate about getting you back in the game, and staying in the game. Our team is fully committed to returning you to the life and activities you love."

Dr Ong Kee Leong

About Dr. Ong Kee Leong

Senior Consultant, MBBS (Singapore), MMed (Ortho), FRCSEd (Ortho)

Dr. Ong Kee Leong is a fellowship-trained orthopaedic surgeon. He subspecializes in shoulder and knee, foot and ankle, hand wrist and elbow surgeries, arthroscopic sports surgery, and the management of sports-related injuries.

He has been registered with the Singapore Medical Council as a specialist in Orthopaedic Surgery since 2011.

  • MBBS, National University of Singapore (NUS) Faculty of Medicine 2001
  • Member of the Royal College of Surgeons of Edinburgh 2007
  • Master of Medicine in Orthopaedic Surgery (NUS) 2007
  • Fellow of the Royal College of Surgeons of Edinburgh in Orthopaedic Surgery 2011
  • Health Manpower Development Plan (HMDP) Scholarship, Ministry of Health 2012-2013:
  • Sports Surgery and Arthroscopy in Germany (Hannover)
  • Adjunct Assistant Professor, Lee Kong Chian School Of Medicine, Nanyang Technological University
  • Senior Clinical Lecturer, Yong Loo Lin School of Medicine, NUS
Awards & Teaching
  • Dr. Ong had received numerous awards such as Best Service and Eastern Health Alliance Caring (Gold) Awards.
  • He also has an interest in clinical research and has written papers in multiple peer-review journals. As a Core Faculty of Singhealth Orthopaedic Surgery Residency Program, he oversees the training of junior orthopaedic surgeons.
  • Regularly invited to teach local and regional surgeons in Shoulder and Knee Surgery Courses.
  • He is a recipient of multiple teaching awards including the Singhealth Residency Outstanding Faculty Awards from 2014-2016 and Changi General Hospital Outstanding Educator Awards 2015-2016.

Why Do Patients Choose Dr Ong Kee Leong?

  • Dr. Ong Is Passionate In Sports, Giving Him A Deep Understanding Of Sports-Related Injuries And How They Can Be Treated
  • Fellowship Trained Surgeon With 15 Years Of Experience In Orthopaedic Conditions
  • Personalised And Professional Approach To Deliver High-Quality Orthopaedic Care Based On The Most Up-To-Date Literature
  • Detailed Aftercare Plan To Ensure Smooth, Long-Term Recovery
  • Problem-Oriented, Well-Organised and Individualized Treatment Plans Catered To Your Specific Needs
  • Specialist In The Management Of Sports Injuries And Degenerative Conditions Of The Shoulder And Knee Joints
  • Knowledgeable And Pleasant Clinical Staff To Assist You With Your Every Need Detailed Aftercare Plan To Ensure
  • Our Care Is Conveniently Accessible At Mount Elizabeth Novena and Farrer Park hospital
  • Minimal Waiting Time For Initial Consultation
  • Assistance With Medical Claims (e.g. Medisave & Integrated Shield Plans)

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