Get Back to Running: How Physical Therapy Can Help with Runner's Knee
What is Runner's Knee?
Runner's Knee, also known as patellofemoral pain syndrome, is a condition that affects the knee joint and is characterized by pain around the patella (knee cap), swelling, and limited mobility. It is among the most common injuries seen in runners, with a prevalence rate of 15.6% compared to other injuries [1]. Runner's Knee not only affects runners but can occur in other high-impact sports as well.
Getting treatment for Runner's Knee is crucial for runners and other athletes who undergo high impact and stress on their knee joints during training and/or competition. Ignoring the symptoms of Runner's Knee can lead to other injuries and may even force an athlete to miss extended time. Physical therapy is one of the most effective ways of treating Runner's Knee symptoms, restoring normal knee function, and returning to sport. This article will explore the causes of Runner’s Knee and how physical therapy can help.
What Are The Causes of Runner's Knee?
The exact cause of Runner's Knee is not well understood, but it is believed to result from a combination of factors, including overuse, improper training techniques, muscle weakness, and a history of previous injuries.
Overuse: Running too much, too fast, or increased high-impact activities without proper preparation
Improper Training Techniques: Running form, wrong shoes, or lack of recovery
Muscle Weakness: There is strong evidence demonstrating a significant association between Runner's Knee and hip muscle weakness, specifically the hip external rotator and hip abductor muscles. This can cause excessive hip adduction and internal rotation during running, which could lead to lateral patella tracking and increased contact pressure in the lateral aspect of the patella [2]
Previous Injury: A history of prior injuries can increase the risk of developing Runner's Knee [3]
There are many factors that can lead to the development of Runner’s knee, so it is important to identify and address these triggers. Early detection and treatment of Runner's Knee can help prevent the development of chronic pain, forced time off, and occurrence of other injuries.
How Does Physical Therapy Help Runner's Knee?
Physical therapy plays a crucial role in the treatment of Runner's Knee. At Resilience Physical Therapy, we can help individuals with Runner's Knee develop a recovery plan that addresses the underlying cause of their pain, help to restore normal knee function and provide a plan to return to sport.
Treatment for Runner’s Knee typically includes a combination of techniques, including:
Strengthening and Mobility Exercises: We will identify areas of weakness and immobility to recommend specific exercises which can help improve knee stability and reduce pain [Click here for some exercise examples]
Manual Therapy: We will implement soft tissue release, joint mobilization, taping techniques etc., to help reduce pain and improve knee mobility
Coaching: We will perform a running form analysis, make recommendations on appropriate footwear, and create a training plan to help prevent further injury and provide a safe transition back to sport
Our mission is to help support athletes through rehab by providing the latest techniques and evidence-based practices to achieve their goals and get back to doing what they love. Our physical therapists are dedicated to providing personalized, one-on-one care and developing individualized treatment plans to meet each athlete's specific needs. If you are experiencing knee pain due to running or other sports, our team would love to help. Schedule a discovery call to see if we are the right fit for you!
References:
Lopes AD, Hespanhol Júnior LC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A Systematic Review. Sports Med. 2012 Oct 1;42(10):891-905. doi: 10.1007/BF03262301. PMID: 22827721; PMCID: PMC4269925.
Xie P, István B, Liang M. The Relationship between Patellofemoral Pain Syndrome and Hip Biomechanics: A Systematic Review with Meta-Analysis. Healthcare (Basel). 2022 Dec 28;11(1):99. doi: 10.3390/healthcare11010099. PMID: 36611559; PMCID: PMC9818693.
van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007 Aug;41(8):469-80; discussion 480. doi: 10.1136/bjsm.2006.033548. Epub 2007 May 1. PMID: 17473005; PMCID: PMC2465455.
Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. J Sport Health Sci. 2021 Sep;10(5):513-522. doi: 10.1016/j.jshs.2021.04.001. Epub 2021 Apr 20. PMID: 33862272; PMCID: PMC8500811.
Training Tips to PR your Next Downhill Marathon
Signing up for a downhill marathon to break your PR? Chasing the elusive Boston Marathon qualification? Or just getting into trail running? Everybody loves a fast marathon and what better way to do it than with a downhill course – let gravity do some of the work, right? Well…not quite. Surprisingly, downhill courses can be more challenging for our bodies compared to running on flats or uphills. First, let's explore why that is, then we'll leave you with some training tips so you can perform your best come race day.
So what makes downhill running challenging?
Higher mechanical strain:
Running downhill might feel easy for a short time, but your muscles, especially the quads, undergo higher mechanical strain. The repetitive lengthening of your muscles helps decelerate your body's center of mass under load; this strain leads to acute and delayed muscle damage [1].
Strike pattern:
Most runners adopt a heel-strike pattern when running downhill, which alters the ground reaction forces during initial ground contact. This foot strike pattern leads to significant impact and braking forces on your joints compared to running on flats [2].
These factors cause a significant decrease in running economy and performance during a downhill race, so preparing with a robust training program is essential.
Now here are those training tips we promised:
Tip #1: Add eccentric strength exercises into your training routine
Eccentric exercises mimic the muscle lengthening action we rely on when running downhill. Performing eccentric strength training has been shown to limit the effects of exercise-induced muscle damage caused by downhill running and maximize strength production [3,4,5].
Click here to see which eccentric strength exercises you should add to your training routine
Tip #2: Exposing your body to downhill running before your race
If you want to get better at running downhill, you need to practice running downhill. Add specific downhill sessions to your training, such as hill repeats or tempo/fartlek runs with downhill portions mixed in. This will allow your body to tolerate downhill runs better and provide a protective adaptation that can reduce exercise-induced muscle damage leading to enhanced performance [6,7,8]. You don't have to be training for a downhill marathon to add this to your workout. Running downhills in training has also been shown to improve running performance and efficiency on flat courses [9].
Tip #3: Make sure to run in your racing shoes during training
Running downhill puts more stress on the forefoot and toes. Doing some training runs in your racing shoes can help identify any hot spots so you can make proper adjustments come race day.
Tip #4: Start small and allow proper recovery time in between downhill running sessions to avoid injury
When beginning to implement hill runs, start on a lower grade before increasing incrementally to an elevation similar to your upcoming race, if possible. The effects of downhill running on your body, such as increased muscle strain, can lead to delayed onset muscle soreness lasting up to 96 hours. Allow at least 48 hours after a downhill session before scheduling your next high-effort run to avoid overload.
Click here if you are just getting back into running and want to learn how to do it safely
If you are experiencing pain or currently dealing with an injury and need help, contact us for a discovery call!
Giandolini M, Vernillo G, Samozino P, Horvais N, Edwards WB, Morin JB, et al. Fatigue associated with prolonged graded running. Eur J Appl Physiol. 2016;116(10):1859–73.
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Lemire M, Hureau TJ, Favret F, Geny B, Kouassi BYL, Boukhari M, et al. Physiological factors determining downhill vs uphill running endurance performance. J Sci Med Sport. 2020. https:// doi.org/10.1016/j.jsams.2020.06.004.
Byrnes WC, Clarkson PM, White JS, Hsieh SS, Frykman PN, Maughan RJ. Delayed onset muscle soreness following repeated bouts of downhill running. J Appl Physiol (1985). 1985;59(3):710–5.
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Bontemps B, Vercruyssen F, Gruet M, Louis J. Downhill Running: What Are The Effects and How Can We Adapt? A Narrative Review. Sports Med. 2020 Dec;50(12):2083-2110. doi: 10.1007/s40279-020-01355-z. PMID: 33037592; PMCID: PMC7674385.
How To Modify Your Running Plan To Avoid Injury And Stay Consistent
A proper running plan continuously evolves depending on how your body is adapting. Maybe you had a long stressful week with little sleep and not feeling 100%. The last thing you want is to develop an injury that sidelines you. The biggest challenge of any running plan is staying consistent and by modifying your workouts based on what your body tells you can help.
Here are a few ways you can modify your training plan when not feeling 100% to stay consistent:
✅ Decrease the pace of your runs
The faster you run, the more force your joints, muscle, and soft tissue need to absorb
✅ Decrease your mileage on specific runs
This can offload your body and help with recovery
✅ Don't run consecutive days
After a high-effort session such as an interval or tempo run, allow 48 hours for your body to recover
*These are temporary modifications to avoid injury, especially when you're not feeling 100%. Do not run if you have pain that alters your running mechanics, and seek guidance from a physical therapist if pain persists. If you are experiencing pain or currently dealing with an injury and need help, contact us for a discovery call!
Plyometric Exercise Progressions For Running Speed and Efficiency
Why should you start doing plyometric exercises?
Plyometric exercises are a great way to improve your rate of force development and energy storage through your tendons. This translates into faster and more efficient running by increasing your maximal force output when your foot hits the ground.
Here is a plyometric exercise progression starting from easiest to hardest:
Jump Lunges w/o Switch
Jump Lunges w/ Switch
Single Leg Sprint Jumps
If you are interested in working with us, schedule a free discovery call!
Rearfoot Strike versus Forefoot Strike, Which one is better?
This is a common question that I come across with many runners, which foot strike pattern should I choose to help me run better?
There is little scientific evidence showing that one-foot strike is more beneficial than the other. A rear-foot strike is more commonly seen in recreational runners and transitioning to a forefoot strike does not mean improvements in running economy or reduced risk of injuries.
However, there are certain situations where transitioning to a different strike pattern can help. This is based on many factors such as injury history, running analysis findings, movement assessment, footwear etc.
If you are in the process of changing your foot-strike pattern, make sure to modify your running mileage/training accordingly and perform specific strength exercises to help your body transition smoothly.
If you are interested in working with us, schedule a free discovery call!
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Xu Y, Yuan P, Wang R, Wang D, Liu J, Zhou H. Effects of Foot Strike Techniques on Running Biomechanics: A Systematic Review and Meta-analysis. Sports Health. 2021 Jan/Feb;13(1):71-77. doi: 10.1177/1941738120934715. Epub 2020 Aug 19. PMID: 32813597; PMCID: PMC7734358.
Thompson, Missy et al. “The Coupling of Stride Length and Foot Strike in Running.” Frontiers in sports and active living vol. 4 768801. 12 Apr. 2022, doi:10.3389/fspor.2022.768801