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Jenn works full-time and then some as a managing director at a media agency in New York. She’s also a devoted mother to a little boy and a girl. She’d been running half marathons for a while but last year, she decided it was time to run a Full Marathon (since she had so much spare time).
She’d always wanted to run the New York Marathon and was thrilled when she got the opportunity through a charity raise with Team For Kids. The only problem was that she’d been out of running for four months with knee pain.
It started as a pretty mild general ache around the front of her knee after long runs. It got worse over the next few weeks. Eventually, she had to cut runs short. That’s when she went to see her local Physical Therapist. She was diagnosed with Patellofemoral Pain, more commonly known as Runner’s Knee.
Over the next few months, she worked with her Physical Therapist to reduce the pain and slowly ease back into a little bit of running. Her PT was happy to discharge her at that point. Jenn was pleased to be back to running, but she was worried that she’d “blow up the knee” when she started marathon training.
Scared to Run due to Knee Pain
Jenn scheduled a free call with me so we could dig into it a little more. She explained everything that had happened with her knee over the last six months. She was running a little bit, but nowhere near the volume she’d need to hit to be ready for the marathon. She wasn’t having any pain with running anymore, but she still felt pain behind her kneecap when she tried to do lunges.
I asked what she was most worried about and she explained that she was scared to run a lot. She felt like the knee was just going to blow up again. We talked about her goal to run the New York Marathon. It was 11 months away, so Jenn still had time on her side. However, it was clear that Jenn was feeling pretty anxious about the knee.
Jenn explained that running was her “me time”. Her chance to decompress from the business of her life. Losing that over the last few months had been awful. So she didn’t want to risk irritating the knee again and having to take another break from running. At the same time, doing this marathon meant everything to her. She had dreamed of it for years and was finally in a position to make it happen. She said she’d be devastated if she couldn’t do it.
This sucked for Jenn. She shouldn’t have to choose between running for “me time” and stretching herself to do her dream race. She should be able to do both.
Patellofemoral Pain in Runners
Jenn and I discussed what patellofemoral pain actually is and how to fix it. Jenn understood the basic anatomy and pathology very well. The patellofemoral joint is the articulation between the kneecap (the patella) and the thigh bone (the femur). The patella is a floating bone within the quadriceps tendon.
When you bend your knee, the quadriceps tendon is bent around the femur. Nature created a little floating bone (our kneecap) to stop the tendon from fraying and breaking at the point where it contacts the femur. So the job of the kneecap is to take the pressure in place of the tendon. So when you bend your knee, the back of the kneecap presses up against the thigh bone.
Each time you land when you’re running, the kneecap is pressed up against the thigh bone. This is totally normal, that’s it’s job. The problem is, if there is too much pressure on one particular spot on the kneecap, over and over, for a long time, you develop pain in that spot. I think of it like a “hot spot”.
At first, that hot spot on the back of your kneecap just feels like a general discomfort around the front of your knee. That’s what Jenn felt at first. As it gets worse though, it becomes more painful and you might even be able to feel that the pain is coming from the back of the kneecap. It will usually feel worse on longer runs and if it gets bad enough, you’ll often feel it walking downstairs.
I explained to Jenn that the real problem wasn’t just that there was too much pressure on the kneecap, but also, that the kneecap wasn’t tough enough to handle that pressure.
How Do I Stop My Knees From Hurting When I Run?
I outlined a plan for Jenn that would focus on two objectives.
- Reduce the pressure on the back of the kneecap
- Make the kneecap tougher, so it can handle more pressure
Reduce the Pressure on the Back of the Kneecap
To reduce the pressure on the back of the kneecap we’d need to look at her running technique. When we did the analysis, it was great to see that Jenn wasn’t making any of the major errors that would significantly increase the stress at the knee such as knock knee running or overstriding.
She did have a bit of a pelvic drop, so we got her doing some drills to reduce that.
Jenn was already pretty familiar with taping techniques for Runner’s Knee. These are simple techniques that attempt to move pressure off the “hot spot” on the back of the kneecap. They often work really well as a short-term strategy that allows you to do more running and rehab.
We also got Jenn doing some really heavy strength training. The evidence that strength training reduces pain from Runner’s Knee is really good. Making the muscles stronger and more powerful, allows them to better attenuate the forces experienced during running. Said more simply, if the muscles can take more of the stress, less goes on the bones and joints.
If you want more detail on the best strength exercises for Runner’s Knee, just check out my episode appropriately titled Strength Exercises for Runner’s Knee. I know, I must have been feeling really creative when I came up with that title.
Make the Kneecap Tougher, so It Can Handle More Pressure
To make the kneecap tougher, we’d primarily use running. Very slowly and systematically we increased the stress on the kneecap each week. This sends a signal to the body that we want that area to be stronger. With appropriate recovery and nutrition, the body will make the back of the kneecap tougher, so it can handle more stress.
During this process, we’d monitor the symptoms closely using the traffic light system. If Jenn experienced any red light pain with a given run, she’d stop. If the pain was pretty mild, only a green-light, she’d keep going. If it was a bit more noticeable, but not quite in the red, she’d continue with caution and let me know. That way I could constantly tweak the runs for the following week.
Little by little, we increased the volume and intensity of her running. Gradually inching her closer to marathon training levels.
Jenn was particularly apprehensive about lunges. Flat out refusing to do them at first. As she started to see progress though, she became more confident that the back of her kneecap could handle the stress. After a few months, she was able to do lunges with heavy dumbbells with no pain. Her kneecap was getting pretty tough.
Getting Up To Full Marathon Training
Six months after we began working together Jenn ran her first three-and-a-half-hour run. She was up to 65 km per week by then and hadn’t thought about her knee in months. Now she’s just a few weeks out from the NYC Marathon and enjoying her most intensive phase of training yet.
Jenn could have taken the easy way out. She was scared that increasing her mileage and attempting to train for the NYC marathon would flare up her knee. The truth is, she had good reason to be. Most runners afflicted by runner’s knee never fully get rid of the pain. Many of them simply reduce their training so they don’t make the pain worse. Jenn didn’t choose that path.
When we met, Jenn was running, but not training. She wasn’t able to push herself towards her dream because she was scared of damaging her knee. But she faced her fear and conquered her knee pain. Now she is preparing for her first ever marathon. Her Dream Race no less. The New York City Marathon.
If you feel like you’re running, but not training and you’re worried about damaging your knees, we can help. Just click the button below to book a free call with us.