Runner's Knee
Runner’s knee (patellofemoral pain syndrome) is a dull pain around the front of the knee (patella), where the knee connects with the lower end of the thighbone (femur).
The patella (kneecap) is the moveable bone on the front of the knee. The underside of the patella is covered with articular cartilage, the smooth, slippery covering found on joint surfaces. This covering helps the patella glide in the femoral groove made by the femur.
Runner’s knee occurs when the patella suffers wear and tear. The underlying cartilage begins to degenerate (chondromalacia patella). Wear and tear could be the result of alignment or overuse problems of the patella, or it could be a part of the aging process. This produces pain, weakness, and swelling of the knee joint.
Overuse. Bending your knee again and again or doing a lot of high-stress exercises, like lunges and plyometrics (training that uses the way your muscles lengthen and shorten to boost their power), can irritate tissues in and around your kneecap.
A direct hit to the knee. A fall or blow may knock the patella out of place.
Bone structure. Some people are born with a greater than normal angle where the femur and the tibia come together at the knee joint. This may cause the patella to shift outward with greater pressure when the quadriceps muscle contracts, damaging the articular cartilage. People with a shallower-than-normal femoral groove, or a high-riding patella that sits too high on their femur, are also at higher risk of a patellar dislocation.
Muscle imbalances/weakness. Having weak quadriceps or hip abductor muscles could lead to muscle imbalances. This could cause the patella to pull more to one side than the other, putting uneven pressure on the articular cartilage and damaging it. Mistimed quadriceps muscles could also cause the patella to be pulled off track.
Feet problems. Hypermobile feet (when the joints in and around the feet move more than they should, fallen arches (flat feet), or overpronation (feet roll down and inward when you step) may change the way you walk, leading to knee pain.
Pain, weakness and instability in and around the kneecap when you are active, or after sitting for a long time with the knees bent.
Pain worsens when talking downstairs / downhill
Rubbing, grinding, or clicking sound of the kneecap when you bend and straighten your knee
Kneecap tender to the touch
Swelling around the knee
The doctor will give you a thorough physical exam. They might also do tests that can give them a closer look inside your joint, like X-rays.
Using the RICE (rest, ice, compression, elevation) method: The RICE method involves resting your knee, icing your knee, wearing an elastic bandage around your knee (compression) and elevating your knee while you’re resting. This helps to reduce pain and swelling.
Taking pain relievers: Your healthcare provider may recommend taking pain relievers (non-steroidal anti-inflammatory medications, or NSAIDs) to help reduce pain and swelling in your knee. Acetaminophen can be used as an alternative if you cannot tolerate NSAIDs or are allergic.
Wearing a knee brace: Bracing or taping the patella can help you do exercises and activities with less pain. This helps the patella stay in better alignment within the femoral groove, and also improves the pull of the quadriceps muscle so that the patella stays lined up in the groove. Therapists may also design special shoe inserts (orthotics) to improve knee alignment and function of the patella.
Doing physical therapy: As the pain and inflammation become controlled, you should focus on improving flexibility, strength, and muscle balance in the knee. Muscle imbalances are commonly treated through stretching and strengthening exercises. These aim to increase the flexibility of the thigh and calf muscles, and to maximize control and strength of the quadriceps muscles.
If nonsurgical treatment fails to improve your condition, surgery may be suggested. The procedure used for patellofemoral problems varies. In severe cases a combination of one or more of the following procedures may be necessary.
Click on the dropdowns below to learn about the various surgical procedures for runner’s knee.
Arthroscopic Method
Looking directly at the articular cartilage surfaces of the patella and the femoral groove is the most accurate way of determining how much wear and tear there is in these areas. Your surgeon can also watch as the patella moves through the groove, and may be able to decide whether or not the patella is moving normally. If there are areas of articular cartilage damage behind the patella that are creating a rough surface, special tools can be used by the surgeon to smooth the surface and reduce your pain. This procedure is sometimes referred to as shaving the patella.
Cartilage Procedure
In more advanced cases of patellar arthritis, surgeons may operate to repair or restore the damaged cartilage. The type of surgery needed for articular cartilage is based on the size, type, and location of the damage. Along with surgical treatment to fix the cartilage, other procedures may also be done to help align the patella so less pressure is placed on the healing cartilage.In more advanced cases of patellar arthritis, surgeons may operate to repair or restore the damaged cartilage. The type of surgery needed for articular cartilage is based on the size, type, and location of the damage. Along with surgical treatment to fix the cartilage, other procedures may also be done to help align the patella so less pressure is placed on the healing cartilage.
Lateral Release
If your patella problems appear to be caused by a misalignment problem, a procedure called a lateral release may be suggested. This procedure is done to allow the patella to shift back to a more normal position and relieve pressure on the articular cartilage. In this operation, the tight ligaments on the outside (lateral side) of the patella are cut, or released, to allow the patella to slide more towards the center of the femoral groove. These ligaments eventually heal with scar tissue that fills in the gap created by the surgery, but they no longer pull the patella to the outside as strongly as before the surgery. This helps to balance the quadriceps mechanism and equalize the pressure on the articular cartilage behind the patella.
Ligament Tightening Procedure
In some cases of severe patellar misalignment, a lateral release alone may not be enough. For problems of repeated patellar dislocations, the surgeon may also need to realign the quadriceps mechanism. In addition to the lateral release, the tendons on the inside edge of the knee (the medial side) may have to be tightened as well.
Bony Realignment
If the misalignment is severe, the bony attachment of the patellar tendon may also have to be shifted to a new spot on the tibia bone. Remember that the patellar tendon attaches the patella to the lower leg bone (tibia) just below the knee. By moving a section of bone where the patellar tendon attaches to the tibia, surgeons can change the way the tendon pulls the patella through the femoral groove. This is done surgically by removing a section of bone where the patellar tendon attaches on the tibia. This section of bone is then reattached on the tibia closer to the other knee.
Usually, the bone is reattached onto the tibia using screws. This procedure shifts the patella to the medial side. Once the surgery heals, the patella should track better within the center of the groove, spreading the pressure equally on the articular cartilage behind the patella.
Many surgeons will have their patients take part in formal physical therapy after knee surgery for patellofemoral problems. Patients undergoing a patellar shaving usually begin rehabilitation right away. More involved surgeries for patellar realignment or restorative procedures for the articular cartilage require a delay before going to therapy. Rehabilitation may be slower to allow the bone or cartilage to heal before too much strain can be put on the knee.
The first few physical therapy treatments are designed to help control the pain and swelling from the surgery. The physical therapist will choose exercises to help improve knee motion and to get the quadriceps muscles toned and active again. Muscle stimulation, using electrodes over the quadriceps muscle, may be needed at first to get the muscle moving again.
As the program evolves, more challenging exercises are chosen to safely advance the knee's strength and function. The key is to get the soft tissues in balance through safe stretching and gradual strengthening.
The physical therapist's goal is to help you keep your pain under control, ensure you place only a safe amount of weight on the healing knee, and improve your strength and range of motion. When you are well under way, regular visits to the therapist's office will end. The therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.
How using the HeatPulse
and Thermosleeve can help
The Thermosleeve and HeatPulse are great tools for hot and cold therapy to help you recover from your surgery.
Thermosleeve combines cold with compression for greater effectiveness in relieving pain and inflammation
HeatPulse combines heat and massage to boost blood flow to your knee, encouraging healing and improving range of motion
Swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, you can use the Thermosleeve three to four times a day for about 10-20 minutes during the first few days after surgery.
After the initial swelling has gone down, you can alternate between the Thermosleeve and the HeatPulse to relax the muscles and ease stiffness.
The Thermosleeve and HeatPulse are great tools for hot and cold therapy to help you recover from your surgery.
Thermosleeve combines cold with compression for greater effectiveness in relieving pain and inflammation
HeatPulse combines heat and massage to boost blood flow to your knee, encouraging healing and improving range of motion
Swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, you can use the Thermosleeve three to four times a day for about 10-20 minutes during the first few days after surgery.
After the initial swelling has gone down, you can alternate between the Thermosleeve and the HeatPulse to relax the muscles and ease stiffness.
Hear from customers
who have experienced relief
