Forty-two percent of all overuse injuries affect the knee joint, and patellofemoral pain syndrome (PFPS), or simply “runner’s knee,” is the most common overuse injury among runners. It occurs when a mistracking kneecap (patella) irritates the femoral groove in which it rests on the thighbone (femur).

Now let’s break this down for a second for a quick lesson in anatomy. There are tendons and ligaments and other connective tissues that keep the bones of the upper leg and lower leg and the patella together in one unit. This allows you smooth movement without pain or inflammation.

The problems occur when the tendon that holds the patella (patella tendon) loosens or stretches it can cause the kneecap to wobble from side to side, which has a knock-on effect in the femur bone as it hits the side of the femoral groove causing inflammation.

Knee injuries can lead to problems in the hips and back, affecting your posture

Pinpointing a single cause is difficult. It could be a biomechanical problem — the patella may be larger on the outside than it is on the inside, it may sit too high in the femoral groove, or it may dislocate easily. Also, worn cartilage in the knee joint reduces shock absorption, high-arched feet provide less cushioning, and flat feet or knees that turn in or out excessively (overpronation/supination) can pull the patella sideways.

There are also muscular causes. Tight hamstring and calf muscles put pressure on the knee, and weak quadriceps muscles can cause the patella to track out of alignment. Just the repetitive force of a normal running stride alone can be enough to provoke an attack.

PFPS can affect one or both knees. It strikes mostly younger, recreational runners and twice as many women as men, according to the British Journal of Sports Medicine. (Women tend to have wider hips, resulting in a greater angling of the thighbone to the knee, which puts the kneecap under more stress.)

Symptoms include tenderness behind or around the patella, usually toward its center. You may feel pain toward the back of the knee, a sense of cracking or that the knee’s giving out. Steps, hills, and uneven terrain can aggravate PFPS.

To prevent PFPS, run on softer surfaces, keep mileage increases less than 10 percent per week, and gradually increase hill work in your program. Visit a specialty running shop to make sure you’re wearing the proper shoes for your foot type and gait (see my previous blog on buying the right running shoes!). Also, strengthening your quadriceps will improve patellar tracking, and stretching your hamstrings and calves will prevent overpronation.

At the first sign of pain, cut back your mileage or even stop running completely. The sooner you lessen the knee’s workload, the faster healing begins — and don’t think that even if the pain disappears briefly that it won’t come back to haunt you! Avoid knee-bending activities, canted surfaces, and downward stairs and slopes until the pain subsides. As you rebuild mileage, use a smaller stride on hills. Consider orthotics if new shoes don’t fix the problem as this is more of a long-term solution.

Other tips for avoiding Runner’s Knee:

• Always spend at least 15 minutes stretching after every workout.

• Vary your exercises! Not surprisingly, runners tend to focus on one and only one method of exercise: running. Doing so tends to bring the body out of balance. In the case of runners, they tend to end up with hamstrings (the muscles the run along the back of the thigh) that are stronger than their quadriceps (which run along the front of the thighs.)

Plenty of varied lunges and squats together with deadlifts and core-strengthening workouts will help strengthen both the front and the backs of thighs, as well as the muscles of the hips and buttocks.

• Don’t overdo it! Overtraining is one of the most common reasons for running injuries in general. Don’t launch yourself into any long distances if you haven’t adequately built up your foundation fitness level. Trust me, it isn’t worth the pain and disappointment when you end up having to take a month or two off because of an injury. Try not to increase your mileage by more than 10% a week and always incorporate rest days into your schedule.

• Eat right, supplement wisely. Runners need to the right types of nutrients in order to maintain healthy joints. Experts recommend adults get 1,000–1,200 milligrams of calcium each day. Dark green vegetables and dairy products are the best sources of calcium.
Additionally, many runners take glucosamine and chondroitin sulfate supplements. Glucosamine is an amino sugar that seems to play a role in cartilage formation and repair, and chondroitin is a complex carbohydrate that helps cartilage retain water and maintain its elasticity. I usually take glucosamine supplements in the month or two lead-up to a half-marathon or marathon. But do be aware that glucosamine is essentially extra sugar in your diet, so do check with your GP or doctor if you have high blood sugar levels or are Diabetic.
Although the supplements don’t help everyone, some research has shown that taking the two together can provide relief for people with moderate-to-severe osteoarthritis pain.

• Apply some temporary relief as you hit the pavements again. One of the best products on the market is the Pro-Tec Knee Patellar Tendon Strap. This will tighten up the patella tendon that holds the kneecap in place, so that it doesn’t wobble side to side and instead moves up and down. You can strap this above the kneecap (if the injury is more ITB-related) or below the kneecap, applying the spot pressure pad on the area that causes the most pain. This is comfortable enough to wear during your running.

Good luck and happy running!

How to avoid ‘Runner’s Knee’