Treating Knee Pain in Runners

As the snows melts many of us will return to the amazing Boulder trail system for our training runs.  This popular form of exercise comes with tremendous health benefits, but can also place some runners at risk for running injuries such as knee pain.  Patellofemoral Pain (pain on the front of the knee) is the leading cause for medical consultation attributed to a running program (Taunton et al. 2002).  

Authors have suggested multiple reasons for the pain including training errors (too much volume, too soon), weakness and/or tightness in lower body muscles, and poor control of the lower extremity during the running gait cycle.  Loads on the knee joint have been measured at 4-5 times body weight during running (Roos et al. 2012) with higher loads noted in runners with knee pain (Davis et al. 2010).  Physical Therapy remains the gold standard for treatment of this disorder due its' unique ability to identify and treat the specific factors contributing the symptoms in this group of athletes. 

Prior research on knee pain in runners has shown gait retraining to be an inexpensive and effective treatment for reducing pain and improving function.  In particular, cuing to to improve step frequency and to land softer can significantly reduce impact forces at the knee during running.  A recent article in the Journal of Sports Rehabilitation expands on this research and highlights the impact of a multimodal treatment program for runners with knee pain (Esculier et al. 2016).

The authors included 21 runners with > 3 months of knee pain who were running at least 15 km per week.  These runners must have at least 3/10 pain with running and report pain with stair climbing, kneeling and squatting to be included in the study.  All of the runners were evaluated by a Physical Therapist for their running gait as well as an assessment of strength, flexibility, and control of their knee during functional testing.  Each runner underwent treatment for 8 weeks based on this initial examination performing exercises at home in addition to treatments with the Physical Therapist.  Runners were instructed to increase their step frequency to reduce the loading on their knees, as well as, to land softer to reduce the vertical loading on their legs.  

75% of the runners reported success with improved knee pain and function following the treatments.  Interestingly, the 5 runners who reported low to moderate success did not demonstrate significant changes in the forces across the knee at the end of the trial.  These athletes may require further gait retraining to make a significant impact on their symptoms.  

This study highlights the importance of running gait retraining, without the need for expensive bio-mechanical equipment, and strengthening exercises on improving pain and function among runners.  To learn more about how you can improve your knee pain and get back to running contact your local Physical Therapist.