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Introduction

Patellofemoral pain, also known as Runner's Knee, is a common source of knee pain when it comes to runners. It is the pain that is experienced either around the front of, or behind the kneecap.

Signs and Symptoms

Runner's Knee is commonly a gradual onset of pain and not related to any trauma - it's something that will slowly creep up on you as you continue running. You shouldn't experience any swelling around your knee - if you are then this is likely something else. Common signs and symptoms of Runner's Knee may include:

  • Pain when sitting for long periods of time (e.g., working from home)

  • Pain going up and down the stairs

  • Pain squatting or lunging

Causes

1. Sharp increase in training load

The most common cause of Runner's Knee is increasing your training load too early too soon. When running, you want to make sure you are increasing your weekly mileage and the number of runs that you do per week steadily. For your weekly mileage, you should look to increase this no more than 10% per week and your days per week no more than once when starting a new plan. Sharp increases in your training load (e.g., jumping from running once per week to three times per week) can put excess strain on your body, including your knee, which in turn can result in Runner's Knee.

2. Poor running mechanics

Overstriding can put excess stress on the knee and be a cause of Runner's Knee - this is when you are taking too bigger steps and striking the ground in front of your body, rather than underneath your body. The other term for this is cadence - the number of steps you are taking per minute.

3. Underlying strength

When runners have a deficit in hip strength, particularly hip abduction strength which is most commonly seen in females, this can lead to the knee taking an increased load during running.

Treatment

1. Decrease your training load

When returning to exercise, you should adapt the traffic light system so ensure you are are not delaying your recovery. If you get any pain in Amber or Red, it is advised that you stop running as this will likely delay your recovery.

Green = 0-3 pain, Amber = 3-5 pain, Red = 5+ pain

In the short-term, make sure to take time away from running to let your knee pain reduce. Stay active with activities such as walking and cycling, but avoid high impact sports. Once your pain has subsided and you can sit, walk up/down stairs and squat pain-free, look to gradually build back into running with some easier runs until you are able to run comfortably without pain. You can adjust the number of runs per week, or your running ability, easily from within the Runna app and your plan will adapt accordingly.

2. Increase your cadence

You want to be targeting a cadence of 180 steps-per-minute (you can easily find out your current cadence with a smartwatch) which will reduce your vertical oscillation and distribute the running load more effectively. Try to maintain your current pace but take shorter, faster strides. It's worth practicing this on your easy runs first. Some watches even have a metronome feature to help you set a particular cadence!

3. Increase your hip strength

As well as the above, you should look to build up control and strength around the hip. Watch the video above for the full tutorials.

Banded side-steps (source)

Look to do some Hip Abductor strength movements such as placing a band around your ankles and stepping side-to-side for 3 rounds of 20 seconds with a medium band, progressing to a stronger resistance.

Step-downs (source)

Place one foot on the top of a step and place your hands on the bony part at the front of your pelvis. Make sure to keep your pelvis level as you step down, effectively loading from the hip down to the knee, to the ankle. Step down slowly with a single leg and touch the bottom of your foot on the floor. Look to start off with 3 rounds of 10-12 steps per leg. As you get stronger, you can bring this down to 8-10 steps with additional weight.

Around the clocks (source)

The focus of this exercise is to improve hip and knee control. Runners that present this injury often strike the ground with knee valgus hip rotation which takes the load away from the hip and transfers it into the knee and shin. Balance on one of your legs and step your other foot out (without touching the ground) forwards, left and right (behind your stationary leg) and behind you. Do this once per day with 3 rounds of 30 seconds on each leg.

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