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Read this next. Medically reviewed by Alana Biggers, M. Essential Stretches for Runners Stretching before you run can help prevent injury. Understanding Osteochondritis Dissecans. What Are Osteochondroses? If you have developed knee pain while running, it's important to target the area that's most affected. Depending on the severity of your knee pain, you may need to see your doctor. Knee pain doesn't have to prevent you from running outside or force you to have to cut your runs short.
The following guide can help you pinpoint the cause of your knee pain and get you back on track with your running schedule. Your knee is comprised of multiple joints. The tibiofemoral joint connects your thigh bone femur to your lower leg tibia. The patella, or kneecap, is a protective structure that connects to the femur and forms the patellofemoral joint. These joints are supported by a network of muscles, tendons, and ligaments that help the knee flex, extend, and rotate minimally through important movements such as walking, running, kneeling, and lifting.
When you start to feel knee pain, you can take steps to diagnose and treat the condition on your own. Many times, there are muscular imbalances that can be managed with exercise or other simple changes.
If the pain persists after a week or so of self-treatment, make an appointment with a physical therapist or physician for evaluation and treatment. Because the joint surrounding the knee supports the weight of your body and is used heavily in both basic daily movements and sports, the incidence of injury in this area is high.
If you feel a sharp, stabbing pain on the outside of your knee, you may be dealing with iliotibial band syndrome ITBS , a very common injury among runners.
The iliotibial band IT band is a band of tissue that runs along the outside of the thigh, from the tensor fasciae latae where it attaches at the top of the hip to the outside of the knee. It helps to stabilize the knee and hip when you run. When the tensor fasciae latae becomes tight, it shortens and puts tension on the IT band. The outside knee area can become inflamed, or the band itself may become irritated, causing pain.
Overtraining is the most common cause, but running on a banked surface, inadequate warm-up or cool-down, or certain physical abnormalities may also lead to ITBS. Studies have shown that self-treatment may be effective in treating IT band syndrome.
Options include reducing your miles and icing your knee to reduce inflammation. The use of anti-inflammatory medications such as ibuprofen may also be helpful. Some studies have also found that wearing softer running shoes may help to alleviate the condition.
You can keep running, but you should stop running as soon as you begin to feel any pain. Reduce hill training and make sure you run on even surfaces until you've healed. If you start to notice the early signs of ITBS such as tightness or a twinge on the outside of the knee , you can prevent it from getting worse by doing strength and flexibility work two to three times a week.
To strengthen the area, try some leg exercises that activate the glutes using light weights or no weights at all. It's also worth having a physical therapist do an assessment to determine any weak areas. Those who have ITBS also often have weakness in their hips. If you have soreness around the front of your knee or possibly behind the kneecap, you may have runner's knee, also known as patella femoral pain syndrome or anterior knee syndrome.
Running downhill, squatting, going up or down stairs, or sitting for long periods of time can aggravate the condition. Researchers have identified different causes of runner's knee. The condition can be caused by a structural problem in the knee joint. It can also be caused by weak muscles, tight hamstrings, a tight Achilles tendon or iliotibial IT band, overtraining, poor foot support, or misaligned gait patterns.
One of the most common causes is weakness in the thigh muscles quadriceps. Your quadriceps hold the kneecap in place so that it tracks smoothly up and down. But if you have quad weakness or a muscle imbalance, the kneecap moves slightly left and right.
This movement causes painful friction and irritation. To treat runner's knee, try icing your knees immediately after running.
This helps to reduce pain and inflammation. Experts also advise elevating the leg and using compression knee wraps and anti-inflammatories like ibuprofen. Arch support in your shoes may also help to alleviate pain in some runners. Stretching and strengthening exercises are also important.
Focus on the quadriceps, which are the muscles that help support and stabilize your kneecap. Simple exercises, such as forward lunges or straight leg raises will help to increase strength in the quads.
Stretching the hamstrings and rolling your IT bands can also help. These exercises should be performed after a run or other exercise when your muscles are warm. You should take time off from running when you notice the onset of runner's knee, but you don't have to quit exercise entirely.
You can cross-train as long as the movement is pain-free. You'll know that it's safe to start running again when you're able to run with a normal gait and without pain.
If you find that you change your movement or compensate because of pain, you're not quite ready. Also, replace your shoes often every — miles as lack of shoe cushioning can also lead to runner's knee. Although some runners can treat and prevent future runner's knee by following the above steps, others may need further treatment. You may need to visit a physical therapist who can guide you in stretches and exercises. If your runner's knee is caused by overpronation foot rolling inward when you run , you may need to see a podiatrist about getting custom-fitted orthotics.
Pain from the top of the kneecap to the top of the shinbone may be an indication of patellar tendinitis, a common overuse injury. The condition is also called jumper's knee because it is common in sports that involve jumping.
Those who have jumper's knee feel pain, tenderness, and possibly swelling near the patellar tendon where the kneecap meets the shin. When the condition is in its early stages, you might only notice it when running. This review gave an insight into the rehabilitation approaches available to rehabilitate runners with AKP.
Education is one of the key strategies that are used in the general rehabilitation of patients. This strategy should be considered to empower runners with the relevant knowledge and skills to prevent or rehabilitate runners with AKP. As suggested by Esculier et al. It is crucial that runners have an understanding of their condition and its management so that they are able to take charge and fully participate in their rehabilitation process.
Kunene et al. Both overtraining and undertraining could contribute to AKP. Therefore, load of training is a critical factor that should be considered when designing prevention and rehabilitation programmes for runners with AKP. According to Esculier et al. They may need to reduce the frequency level of their weekly running, the speed and duration of their training and avoid running on downhill routes.
Within 60 min after training, they should monitor their pain and ensure that it returns to the level it was at before training. Their running distance should be gradually increased, while their symptoms should be monitored before increasing their speed and their level of inclination. Poor hip control has been identified as another contributing factor to AKP among runners Halabchi et al. The drop of the pelvis, hip abduction and internal rotation are related problems that can cause an augmented Q-angle, which may lead to the patellofemoral joint being overloaded on the lateral aspect.
According to Dierks et al. Poor hip biomechanics is a serious problem that is caused by poor control of the hip muscle, which includes mainly the weak gluteus medius and maximus muscles. Therefore, proximal strengthing of the lower limb muscles is necessary to improve hip control Ferber et al. Therefore, a holistic approach is necessary. Gait training is highly effective in the rehabilitation of AKP among runners Bonaccia et al.
According to Willy et al. According to Bonaccia et al. Evidence suggests that foot-landing modification is required to mitigate the problem of AKP in runners. Modifications to foot landing may also improve running performance. Proximal strengthening programmes are among the more effective ways to strengthen weak muscles, including gluteus medius and maximus and vestus medialis oblique muscles, which have generally been found to be weak in runners with AKP.
The weakness of these muscles has been classified as a risk factor for AKP Halabchi et al. Findings from this review suggest that a 3-week hip-abductor-muscle-strengthning protocol is helpful in improving muscle strength, eliminating pain and limiting stride-to-stride knee-joint variability among runners with AKP Ferber et al.
Therefore, proximal strength exercises should be included in the overall rehabilitation programme for runners with AKP. They can also be included as part of AKP prevention programmes. Exercises also play a role in addressing other problems that may lead to AKP e. Further studies are required to provide more evidence on the effectiveness of exercise programmes on these other risk factors. Increased foot pronation is one of the problems that runners with AKP have to face, and it has been identified as one of the intrinsic modifiable risk factors Halabchi et al.
This causes biomechanical problems at the patellofemoral joint, which result in a runner sustaining an AKP injury.
This review has shown that foot orthosis is a useful intervention in the rehabilitation of AKP for runners with increased foot pronation. A medially wedged insole is effective in preventing or reducing knee pain or foot symptoms, foot eversion and eversion velocity amoung runners with pronated foot Boldt et al.
However, foot insoles have a very limited effect on the kinematics of the transverse plane of the tibia or the knee, meaning that they have more of an effect on other variables Rodrigues et al. The outcomes of this study suggest that foot orthoses are considered to be one of the strategies to prevent and rehabilitate AKP among runners with increased foot pronation problems. Therefore, a careful foot assessment and presciption of the appropriate shoes and accessories e.
For this to be achieved, a multimodal rehabilitation programme may need to be designed for runners. Esculier et al. Their multimodal intervension has been successful in mitigating pain and improving function among runners with AKP. Their programme comprises 8 weeks of exercises to strengthen the lower limbs, core strength and motor control.
Furthermore, patients should be educated on running gait and symptom management. Collins et al. In this study, the authors found that exercise, patella taping, foot orthoses and acupuncture are more effective in managing AKP if implemented as part of the multimodal physiotherapy programme.
Therefore, a combination of rehabilitation modalities is a strategy that can be considered to address the diverse AKP problems among runners. Runners need to be screened on a regular basis in order for their clinicians to come up with relevant prevention and rehabilitation programmes for AKP. It is crucial that runners be educated about AKP, it being the most common overuse injury. If runners are empowered, they would be more likely to take ownership of their training load management and adhere to their prevention and rehabilitation programmes without seeking the services of a health care provider e.
The goals of a rehabilitation programme for AKP should include three phases that would be based on the progress of the patient Werner The early phase addresses the impairments such as, among others, pain and swelling, muscle imbalances tightness and flexibility , gait abnormalities and patellofemoral joint-loading issues.
The last phase should focus more on functional exercises. It takes a committed and dedicated runner to adhere to the rehabilitation programme. Anterior knee pain is a challenge to many runners. It is a condition whereby muscle factors require a multidimensional, yet individualised management approach.
This study has identified a range of rehabilitation strategies that have been found to be useful in attempting to prevent this problem and to rehabilitate runners. Such strategies include the education of the patient, gait retraining, exercises, the use of foot orthotics and multimodal rehabilitation.
These strategies are good, but they may need to be modified to suit various contexts. Some communities, especially low socio-economic communities, have limited resources that can make it difficult to access and afford some of the rehabilitation services. Considering the diversity of AKP among runners, this study could not provide comprehensive rehabilitation strategies that address all of the needs, both physical and non-physical, of runners with AKP. Therefore, further interventional studies should be undertaken to address the other needs that runners with AKP have and that they might face as they enter the rehabilitatory phase of their journey back towards a pain-free and mobile life.
The authors are grateful to the University of KwaZulu-Natal and the University of the Witwatersrand for the resources provided for this study.
This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.
How to cite this article: Kunene, S. National Center for Biotechnology Information , U. S Afr J Physiother. Published online Jan Siyabonga H. Kunene , 1 Nomathemba P.
Taukobong , 2 and Serela Ramklass 3. Nomathemba P. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Corresponding author: Siyabonga Kunene, az. Received May 6; Accepted Oct 4. The Authors. This work is licensed under the Creative Commons Attribution License. This article has been cited by other articles in PMC. Associated Data Data Availability Statement Data sharing is not applicable to this article as no new data were created or analysed in this study.
Objectives The aim of this study was to map the range of non-surgical and non-pharmaceutical rehabilitation approaches to AKP among runners. Method A scoping review was conducted in five stages: 1 defining the research question, 2 identifying relevant studies, 3 selecting a topic, 4 charting and collecting data and 5 summarising and reporting the results. Results Thirteen out of articles met the inclusion criteria.
Conclusion This study provided a range of rehabilitation strategies that were found useful in the rehabilitation of AKP. Clinical implications The outcomes of this study make explicit the usefulness of the identified rehabilitation strategies among runners with AKP. Keywords: anterior knee pain, rehabilitation strategies, runners, scoping review, education, gait re-education, exercise, foot orthoses and multimodal rehabilitation.
Review methodology A preparatory assessment of the possible scope and size of the available research literature was conducted. Defining of research question Firstly, a research question was defined by the first author in consultation with three experts, who were sports physiotherapists with at least 10 years of clinical experience and 5 years of research experience. Search strategy After the research question had been defined, a comprehensive process of identifying and selecting relevant studies available from the various databases was conducted by two independent researchers.
Data extraction and analysis The selection of relevant studies was then followed by a process involving the extraction and charting of the data. Ethical consideration This article followed all ethical standards for research without direct contact with human or animal subjects. Results Description of studies The initial search process yielded articles Figure 1.
Open in a separate window. The effect that the orthoses exercised on the knee and hip mechanics was minimal Medially wedged foot orthoses are minimally effective in correcting knee and hip biomechanics Bonaccia et al.
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