What is Runner’s Knee?
Runner’s knee is just pain in the front of the knee when running. It’s an umbrella term, not an actual diagnosis. The medical diagnosis is usually patellofemoral pain syndrome or PFPS. This basically refers to pain coming from the back or underside of your kneecap (patella) where it presses on the thigh bone (femur). Hence the term patello (kneecap) femoral (thigh bone) pain syndrome.
With runner’s knee being more of an umbrella term it is commonly used to describe pain in the front of the knee that doesn’t actually come from the patellofemoral joint. Sometimes it’s coming from the quadriceps tendon, the ITB or referred pain from the hip or back. For now though, I will only be talking about pain coming from the patellofemoral joint.
Why do people get runner’s knee?
Basically, runner’s knee comes from putting more load through the patellofemoral joint than it can tolerate.
There are many ways to address this problem. Most internet advice focuses on various ways to change your biomechanics to alter how much load is placed on the knees when you run. For example, stretching your hamstrings, wearing the right shoes, altering your running technique, foam rolling your ITB. Many articles online talk about the tracking of the kneecap, overpronation of the foot, letting your knee go inwards too much when you run etc.
To me, this approach is a bit upside down.
This is basically trying to reduce the load on the back of the kneecap. It’s what I call a “Protectionist Approach” because you are trying to change things to protect the kneecap from load. You change the shoes, correct the overpronation, roll the ITB, alter your running technique and there you go. You have reduced the load on the back of the kneecap and the pain goes away.
Case closed right? Great result.
When you use the Protectionist Approach and the pain goes down what will you do? That’s right! You will run more! Thereby further increasing the load on the kneecap and it will start to hurt again. Then what will you do? You have already corrected all the biomechanical errors you could find. You’re stuck.
Don’t get me wrong, I have nothing against trying to optimize biomechanics. I also have nothing against trying to temporarily reduce the load on the kneecap. However, rather than just trying to reduce the load on the back of the kneecap (Protectionist Approach) why don’t we also work on increasing the ability of the back of the kneecap to tolerate load? I call it the “Tolerance Approach”.
The Tolerance Approach
With the Tolerance Approach, you initially use all those clever strategies to reduce the load on the back of the kneecap that you will easily find online. When the pain has calmed down a bit you systematically load the back of the kneecap every day. Not too much, not too little. Like baby bear’s porridge.
How do you load the back of the kneecap? All sorts of ways. Lunges, Step Ups, Squats, Step Downs, Bulgarian Split Squats. Not all during the same session obviously. How many reps? How much weight? It depends, you have to experiment. Trial and error.
Strength Training for Runners
This is one of the reasons I’m such an advocate for strength training for runners. You will often hear people say that strength training helps prevent running injuries by improving your biomechanics or the tracking of your kneecap. But what about just straight up making the back of the kneecap get used to load? Tissue tolerance!
Strength training is incredibly important for runners. However, while your knee is really hurting is not the right time to start doing loads of squats. First you have to get it to calm down. Then you can work on improving the tolerance of your kneecap to load.