Home > Blog > Knee Injuries > Runners Knee

Runners Knee

Runners knee is one of the most common causes of anterior (front) knee pain and attributes for 25% of all knee pains and injuries seen and treated in sports injury and physiotherapy clinics including Phoenix Rehab.

Also known as "Patellofemoral Syndrome" or "Anterior Knee Pain", it can also cause pain to be referred

• under and
• around

the patient's knee cap.

It is mainly caused and exacerbated by the way our knee cap moves that causes friction at the back of the knee. Unfortunately the symptoms of runners knee comes and goes depending on your activity levels...and runners knee doesn't only affect runners - it affects both active and sedentary people eg office workers, teachers, housewives, executives etc.

Causes of Runners Knee

Runners knee was originally thought to be caused by the way our patella (our kneecap) moves unnaturally, causing additional stress on the cartilage which leads to pain.

You see our kneecap rests/sits in a groove (medically termed as the patellar or trochlear groove) right in front of the knee on the femur (our thigh bone) and is lined with very thick layer of cartilage. The kneecap is quite mobile, it can:

• glide
• tilt and rotate upwards
• glide upwards, downwards and sideways in this groove

There are a few reasons that can influence or stop the patella from moving properly, all of which increases the forces and friction going through the kneecap, causing and exacerbating patella femoral syndrome. 

These include:

1. Muscle weakness
   
   Weakness in the muscles above and below the knee directly reduces the support around the knee. This causes more weight to go through the kneecap, straining it much more.
   
   Also, we have to note that if the muscles on one side of the knee are weaker than the muscles on the other side, naturally the kneecap will shift slightly to one side in the groove (the stronger side), resulting in increased friction
   
   
2. Muscle Tightness
   
   If the muscles around the kneecap are tight, they will pull the kneecap in the direction of the tightness, usually upwards and sidewards slidely, again, leading to increased friction and then to knee cap pain
   
   
3. Foot Position
   
   Abnormal foot position such as flat feet, will cause the foot to roll inwards/go internally as we walk, jog or run. This alters the way the forces go upwards through the knee, and increases abnormal pressure on our kneecap
   
   
4. Q Angle
   
   The Q angle refers specificly to the angle of the thigh (femoral) bone. An increase in the Q angle puts more strain on the kneecap (increased angle = increased pressure)
   
   
5. Anatomy
   
   If there is abnormality in the shape of the patellar groove and/or the kneecap that causes both of them to be mal-aligned or blocked, that can restrict the movement and cause friction, causing you to develop patellofemoral syndrome

Symptoms of Patellofemoral Syndrome

Runners knee doesn't tend to be a traumatic or sudden issue - it normally develops over time.

Most patients describe/report it as an ache near and around their kneecap, usually underneath or at the sides of the patellar.

In some cases, there may be also presence of "crepitus", which means

• grating
• scraping
• grinding

which is caused by friction on the knee cap.

There are also instances of mild to moderate stiffness and swelling in the affected knee too.

Pain in runners knee tends to not always be there (comes and goes) but will worsen with:

• Prolonged exercises or activities e.g. running long distances, sports, skiing especially when going downhill
  

• Stairs climbing especially coming downstairs
• Standing/moving about after sitting for long periods e.g. at the cinema, office workers, driving long distance.  The knee tends to be stiff and sore when you first get up and then movement and discomfort improves as you move around
  

Treatment Options

Physiotherapy treatment for Runners Knee aims to reduce the kneecap pain and swelling, and address any muscle imbalance in the leg. The most common physiotherapy treatments for patellofemoral syndrome are:

1.  Strengthening Exercises
   
   People with Runners Knee often have weak glutes (buttocks) and quadriceps (front of thighs) muscles. Strengthening these muscles will support the knee better as well as reduce the weight going through the knee.
   
   
2. Stretches
   
   Reducing any muscle tightness (especially those shortened/tight knots in the muscles around the knee) will also improve how the knee cap glides in the patellar groove reducing the friction on the kneecap.
   
   
3. Knee Braces
   
   Braces can help to improve the support around the knee and the position of the patella reducing the pain associated with patellofemoral syndrome.
   
   
4. Orthotics
   
   There are special insoles that can be worn on your shoes to correct your foot position and Q angle and therefore reduce the forces going through the kneecap.
   
   
5. Rest and Pacing
   
   Runners Knee often develops after a sudden increase in activity levels.
   
   We recommend and advise for you to rest for a few days to let your knee pain settle down, and then gradually build up the amount of exercise you do, or switch to non-impact exercise such as swimming.
   
   Remember, pain doesn’t always come on during an activity, it often develops later that day or overnight, so start slowly and gradually increase.
   
   
6. Ice / Cold Therapy
   
   Using ice for ten minutes after activity can help to reduce patellofemoral syndrome pain and swelling.
   
   
7. Avoid Prolonged Postures
   
   If your knee pain comes on mainly after sitting or resting for long periods, try to avoid keeping your leg still. At work, get up and have a little walk around every thirty minutes or so or if that’s not possible, gently move your leg backwards and forwards a few times.
   
   Some of our patients place a ball under their desk which they can then use to move their feet around, keeping their foot, ankle and knees active.
   
   This keeps the joint loose and lubricated which can help reduce patellofemoral syndrome pain.
   
   
8. Painkillers
   
   Over the counter painkillers and non-steroidal anti-inflammatories e.g. Advil/Ibuprofen can be useful to reduce the pain associated with Runners Knee especially during acute / fresh pains.  Always consult your doctor before taking medication - if you need us to refer knee specialists to you, we will be more than happy to.
   
   
9. Surgery
   
   It is very rare that patellofemoral syndrome requires surgery. 
   
   However, if the above physiotherapy treatments do not work after a period of time, then maybe surgery may be indicated to release tight structures around the knee or to remove bits of bone that are irritating the knee cap.
   
   The correct treatment will depend on the cause of your patellofemoral syndrome, so it is always advisable to see your specialist physiotherapist or doctor who can accurately assess what is causing your problem.

The Recovery Process

Recovery for runners knee can take anything from 6 weeks to six months with physiotherapy.

In the early stages of physio, we will focus more on taking the pains away first, then focusing on strengthening and stretching to improve muscle strength, length and stability.

We also have to ramp up your strength over time, allowing your muscles to rest to grow in between sessions, so pacing and resting is equally important part of recovery too.

Between physiotherapy sessions, other than doing what our senior physios teach you to do, you can also participate in lower-impact exercises such as

• swimming
• cycling
• aquarobics
• etc

If you really want to run during this time, please ensure that you have a really good pair of running shoes and try to avoid hills/trains/terrains/hard concrete floor running as these increases the impact and strain on the knees.

Back to Top

book a physiotherapy appointment today

• Email your preferred physiotherapy appointment slot to contact@phoenixrehabgroup.com or
• WhatsApp / SMS your name, preferred date, time and clinic location to +6588001830 (Novena).
• Clinic locations: see how to get to us here

Phoenix Rehab Singapore Core Services And Specializations

Phoenix Rehab Group works with specialist physiotherapists and specialist rehab therapists who are highly trained, qualified, experienced and passionate to provide high level of expert care to our patients.

PHYSIOTHERAPY & PHYSICAL THERAPY General Orthopedic Physio Back and Neck Physio Sports Physio Post-surgery Physio Women's Health Physio Indiba (Radio-Frequency) Physiotherapy Dry Needling Physio

HAND THERAPY &  SPLINTING Patients who sustained injuries to their elbows, forearms, hands, wrists (sprains and fractures) and fingers, and requires Hand Therapy to increase the function of their hand following injuries or post-operations and custom made hand splints.

CLINICAL PILATES & WELLNESS PILATES Clinical Pilates is a form of physical exercise that focuses on posture, core stability, balance, control, strength, flexibility, and breathing. It is a system of safe and effective exercises, which meet specific individual needs, to treat a wide range of injuries and conditions.

TRADITIONAL CHINESE MEDICINE (TCM) Pain Management TCM Acupuncture TCM Gua Sha TCM Cupping TCM

DEEP TISSUE RELEASE & SPORTS MASSAGE THERAPY Sports and deep tissue release massage helps to increase nutrient-rich blood flow to tired , tight and tense muscles to accelerate recovery and shorten downtime. It also helps prevents muscles from scar tissue micro-tears (and future ruptures), and increases muscle performance. When done regularly it will keeps your muscles and you healthy and fit and have body/movement-confidence.

PERSONAL TRAINING Having a dedicated personal trainer/personal training helps you get faster and better health, fitness and wellness results. You can expect better fat loss and muscle gain, have reduced risks of injury, establish effective exercise and health habits as well as overcome those annoying "flatline plateus" to breakthrough to your next level of fitness and weight loss.

All our allied health therapists and TCM physicians are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCMB).

See our entire team here by location and specialization.

At the first session, our specialist physiotherapists will carry out a thorough assessment, helping them to select the most appropriate treatment to help you recover as well as provide treatment in the same session. 

Follow up sessions are inline to provide expert treatment for your pain as well as prescribing specific exercises to reduce your risk of re-injury and giving you a long term solution.

do Tell Your Family, Friends And Colleagues About Us =)

We appreciate you as a patient and want you to know that the #1 (and only) way we grow as a clinic is through word of mouth referrals from valued patients like yourself.

We do not rely on advertising - instead, we prefer and appreciate the goodwill and positive reinforcement from patients. When you have the opportunity, please take the time to tell your family, friends and physicians about the positive results and experience you have had in our clinic.

book a physiotherapy appointment today

• Email your preferred physiotherapy appointment slot to contact@phoenixrehabgroup.com or
• SMS your name, preferred date, time and clinic location to +6588001830 (Novena).
• Clinic locations: see how to get to us here