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Runner’s knee

Runner's knee is also called chondromalacia or patellofemoral pain syndrome, and it a common knee problem for runners, walkers, cyclists and people involved in other sports.

Runner’s knee causes

Runner's knee usually causes aching pain around the kneecap and can be caused by:

  • Overuse. Repeated bending of the knee can irritate the nerves of the kneecap. Overstretched tendons (the tissues that connect muscles to bones) may also cause the pain of runner's knee.
  • Direct trauma to the knee such as a fall or blow.
  • Misalignment. If any of the bones are slightly out of their correct position or misaligned, then physical stress won't be evenly distributed through your body. Certain parts of your body may bear too much weight. This can cause pain and damage to the joints. Sometimes, the kneecap itself is slightly out of position. This may also occur if a runner favours one side or has changed to footwear which is not even. Another trigger may be problems with the lower back of pelvis causing a tilt.
  • Problems with the feet. Runner's knee can result from flat feet, also called fallen arches or over-pronation. This is a condition in which the impact of a step causes the arches of your foot to collapse, stretching the muscles and tendons.
  • Weak thigh muscles.

What does runner's knee feel like?

Symptoms of runner's knee are:

  • Pain behind or around the kneecap, especially where the thighbone and the kneecap meet.
  • Pain when you bend the knee such as when walking, squatting, kneeling, running or even sitting.
  • Pain that's worse when walking downstairs or downhill.
  • Swelling.
  • Popping or grinding sensations in the knee.

To diagnose runner's knee, your doctor will give you a thorough physical examination. You may also be sent for an X-ray, although this may not always reveal much unless a special view is asked for. If the problem does not resolve itself occasionally a referral is made to a specialist who may investigate further. Scans such as MRIs (magnetic resonance imaging) and CT (computed tomography) are not often needed.

What's the treatment for runner's knee?

Regardless of the cause, the good news is that minor to moderate cases of runner's knee should heal on their own. To speed up the healing you can:

  • Rest the knee. As much as possible, try to avoid putting weight on your knee.
  • Ice your knee to reduce pain and swelling. Use a towel to stop the ice from touching the skin directly as this may cause a cold burn. Do this for 20-30 minutes every three to four hours, for two to three days, or until the pain is gone.
  • Compress your knee. Use an elastic bandage, straps or sleeves to give your knee extra support. This is often best applied by a physiotherapist who will do this to draw the kneecap back. With certain knee supports it is possible to make matters worse, so seek advice.
  • Elevate your knee on a pillow when you're sitting or lying down.
  • Take anti-inflammatory painkillers. Nonsteroidal anti-inflammatory drugs ( NSAIDs), like ibuprofen and aspirin, will help with pain and swelling. However, these medicines can have side effects, such as an increased risk of bleeding and ulcers. They should be used only occasionally, unless your doctor specifically says otherwise.
  • Practise controlled stretching and strengthening exercises if your physiotherapist or doctor recommends them.
  • Get arch supports for your shoes. These orthotics, which can be custom-made or bought off the shelf, may help with flat feet. These are ideally fitted by a sports physiotherapist or podiatrist.

Severe cases of runner's knee may need a steroid injection or surgery although this is uncommon. A surgeon could take out damaged cartilage, “clean” the under surface of the kneecap or correct the position of the kneecap so that stress will be distributed evenly.

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