It's important for us to start with a huge DISCLAIMER here. Please see a physician before starting any kind of exercise regimen. What I am listing below is a very general outline of what usually works for patients after a thorough evaluation to confirm the cause of their symptoms. It may not work for everyone or every case and you should seek a formal evaluation and assessment of your concerns. In general, any time you feel numbness and/or tingling in your face, head or jaw, down your arms, or have an upset stomach, abnormal bowel/bladder movements, please discontinue the exercise and seek professional advice.
Understanding the biomechanics will help explain what most professionals believe "Runner's Knee" to be. "Runner's Knee" is a loose diagnosis at best. Any pain in the knee area due to walking, running and climbing stairs is usually given the blanket diagnosis of Runner's Knee.
There are about five different reasons, in my mind at least, that can cause pain in the knee during movement or weight-bearing activities: nerve pain, kneecap pain, knee tendon pain, knee joint pain, and knee fat pad pain. So the first step in treating this generalized knee pain is getting a correct diagnosis of what's causing it.
The knee consists of three actual joints: the patellofemoral (the kneecap), the actual knee joint itself, and a smaller joint. The nuances of these joints are not super important for this particular piece, but it is important to know that there are three joints we are working with. Why, you ask? The knee is NOT A TRUE HINGE JOINT. There is a small rotation that occurs in these joints when you bend and straighten the knee. The kneecap (patella) allows and even assists in the knee's small yet important rotational motion.
What are the common symptoms of "Runner's Knee"?
Pain with jumping and running
Shin splints
Clicking at the knee
Locking at the knee
Grinding, rubbing or burning sensation around the knee
Swelling
Inflexible and stuff midfoot/arch
What would we do about it in office?
At Rehab and Revive, to treat Runner's Knee, we typically start at the ribcage. "But doc, it's my knee that hurts. Why are you touching my ribs??" Proper ribcage alignment down to the hip's ability to extend and rotate during repetitive motions such as walking as a direct correlation with the mechanics of the knee. It becomes a domino effect. One inefficient segment of the body cascades through to other parts of the body and leads to compensations.
Once all of these other pieces are in tip-top shape, we look to see if the knee is off-axis. If that's the case, we use manual therapy techniques to get it back into place!
A little extra information before we get into the exercises:
Before we get to the exercises, it is important to tie all of this information together to know why I chose the exercises I did. In most cases, knee pain is due to a condition called chondromalacia, which means the softening of cartilage most often seen at the kneecap. Knee cartilage only softens for one reason--it is being underused.
Now that may not seem to make sense, because the idea behind Runner's Knee is that there is overuse.
So here's my explanation: the kneecap is pulled by muscles from higher up that make your knee track laterally. The outside half of your kneecap gets overused and the inside half gets underused, thus causing the cartilage softening.
The pain you probably feel isn't necessarily the cartilage, but the friction from the kneecap tracking differently. So restoring the knee's ability to track the kneecap more evenly will help you extend your knee's life.
Increase torques at the knee and kneecap don't just come from using it. The real cause is often coming from the foot, ankle and hip. These three joints can make your knee and kneecap experience excess torques of 7-21 times your body weight. OUCH!
Below are three of my favorite exercises for patients with Condromalacia and Patellar Tendonitis!
Help the knee slide and glide smoothly with increased lubrication and breaking up those bone spurs with this exercise.
I've mentioned the importance of the muscle balance in the leg and hips that have a direct impact on the kneecap tracking above. The hamstrings are such important stabilizers, so get this exercise done and feeling good so you have a better upright posture and muscle balance when weight-bearing.
Now it's time to work on that internal knee brace, which comprises of the hamstring, the vastus medialis obliquus and the soleus muscles. Do this for endurance and it will be the key to getting you back to hiking, running and jumping in no time.
These are just a few of my favorite exercises for my patients suffering from "Runner's Knee". No single program works for everyone, so even if these don't work for you, there may be many others that do! If you find yourself struggling with symptoms of Runner's Knee, it may be worth it to see your local PT and get it checked out!
Remember, we can and we will get better together!
Dr. Justin C. Lin
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