Runner's Knee: Revisited

Triathlon Forum
1

Hello Guys & Gals,

Whatever you want to call it: runner’s knee, PFPS, chondromalacia, etc., I have been dealing with it since last fall. Have seen the orthopede, the PT, reads gobs of online information (a lot of it seems contradictory in terms of causes and solutions).

I am looking for feedback from those who have have suffered or do suffer from this frustrating condition. Tell me what greatest single thing-above all the lore out there-seemed to help you the most (e.g., a particular exercise, a particular stretch, running form, etc.).

Thanks for the responses!

G

2

I’m replying having not had runner’s knee, but instead about 4 years of dealing with ITBS.

ITBS is similar in terms of reading information online, so many conflicting things.

So this year, determined to get rid of this damned issue, i decided to simply try to get the strongest, and loosest legs/hips/calves/glutes/hamstrings that I possibly could. Dedicated myself to it. Squats, leg press, hamstring curls, side leg lifts, band walking, straight leg deadlifts for hamstring and tons of sitting on lacrosse balls and rolling my glutes/hips deep into my butt, etc (basic foam roller did nothing compared to this). Twice a week at the gym with a heavy swim focus early on.

While doing this, started mileage over from nothing. Run 1 minute walk 5 minutes for a total of 15 minutes week 1 (January). By february I would jog 5k. Feb-Mar-Apr (12 weeks) increased my long run by 1.5k each week and got it up to 20k-ish.

Today, running 30k long runs, zero ITBS issues for the first time. I still do all the weight work once a week, have not missed a single week.

So my answer is… everyone will give you different answers based on their own experiences – why not just do everything.

3

I switched to a little lower drop shoe and it went away and never came back. Was running in 8-12mm and went down to 4mm and that did the trick. I found that the brooks pure shoes worked well for me. Have been good for over 5 years now.

4

I run with Altras. Has anybody experienced the opposite effect?

That is, going to a shoe that has more rise versus less rise and did this alleviate or eliminate PFPS symptoms?

5

I also occasionally run in Altras. I found that i wear them out relatively fast and experience knee pain under the cap but switch to new shoes and a little ice and i’m good. If you are having this effect it may be worth trying a different shoe to see if it works for you. Why Altra? For the drop or the toe box?

6

Principally the toe box. I have duck feet (wide fore foot-skinny heel section).

8

I’m kinda the same. I’ve been running in NB 980’s and they are not to bad after a few runs. I think running warehouse has them for around $60. Maybe worth a try. They feel a little speedier than the Altra’s to me and hold up good on longer runs.

9

I’m replying having not had runner’s knee, but instead about 4 years of dealing with ITBS.

ITBS is similar in terms of reading information online, so many conflicting things.

So this year, determined to get rid of this damned issue, i decided to simply try to get the strongest, and loosest legs/hips/calves/glutes/hamstrings that I possibly could. Dedicated myself to it. Squats, leg press, hamstring curls, side leg lifts, band walking, straight leg deadlifts for hamstring and tons of sitting on lacrosse balls and rolling my glutes/hips deep into my butt, etc (basic foam roller did nothing compared to this). Twice a week at the gym with a heavy swim focus early on.

While doing this, started mileage over from nothing. Run 1 minute walk 5 minutes for a total of 15 minutes week 1 (January). By february I would jog 5k. Feb-Mar-Apr (12 weeks) increased my long run by 1.5k each week and got it up to 20k-ish.

Today, running 30k long runs, zero ITBS issues for the first time. I still do all the weight work once a week, have not missed a single week.

So my answer is… everyone will give you different answers based on their own experiences – why not just do everything.

I know that you mentioned this already, but ITBS is a completely different animal than PFPS, as is jumper’s knee, as is patellar tendonitis.
I have done a lot of what you have mentioned above (with and without PT help) with no long lasting results.
I am looking for things that have worked (or shown some promise) for people that differ from the usual remedies.

10

I am looking for feedback from those who have have suffered or do suffer from this frustrating condition. Tell me what greatest single thing-above all the lore out there-seemed to help you the most (e.g., a particular exercise, a particular stretch, running form, etc.).
Dealt with it for a few weeks late winter/early spring and online info helped my understanding. Not sure of cause (which is common) it eventually went away on its own…no change to shoes, routine, stretching, mileage, etc. I thought perhaps the winter treadmill sessions may have been a factor (static surface…), as pain seemed to go away when outdoor running resumed on regular basis (maybe just coincidence).

11

No worries dude, no harm intended, just throwing out something (kind of) related
.

12

I am looking for feedback from those who have have suffered or do suffer from this frustrating condition. Tell me what greatest single thing-above all the lore out there-seemed to help you the most (e.g., a particular exercise, a particular stretch, running form, etc.).
Dealt with it for a few weeks late winter/early spring and online info helped my understanding. Not sure of cause (which is common) it eventually went away on its own…no change to shoes, routine, stretching, mileage, etc. I thought perhaps the winter treadmill sessions may have been a factor (static surface…), as pain seemed to go away when outdoor running resumed on regular basis (maybe just coincidence).

Interesting you mentioned the treadmill.
For me, the most to least amount of PFPS pain in terms of running surfaces are:
Treadmill, pavement, trail running.

I have had to stop running on treadmills all together. I am on my second patch of zero running recovery (it’s been almost a month). The first attempt at recovery I didn’t run for 6 weeks. Swimming (I put a lot of effort in having a decent kick, along with proper core strength and alignment) doesn’t bother me. Biking doesn’t bother me either (mountain or road/tri).

13

I have had chondromalacia before. What is a huge help to getting rid of it is strengthening your VMO. Not the big quad muscles but specifically the VMO. Exercises that do this are:

  • Quad sets where sit on floor and put a towel rolled up or a foam roller (I use the roller) and flex your foot to 90 degrees and tighten your quad so you leg raises up. Hold for 10 seconds. Do 10-15 a couple times a day. Do both legs or just the bad one.
  • Quad sets where clench quad and raise foot off floor about 12 inches. Hold the clench for 10 seconds. Do 10-15 a couple of times a day. As it gets easier, add an ankle weight if have one. If not you can use a theraband around a heavy chair leg or couch leg (just have to make sure the band can stay close to ground) and then wrap around top of foot and do the leg raise. Goal is to just add some sort of resistance to make muscle work harder. Do both legs or just the bad one.
  • Wall sits holding ball between legs and squeeze - hold for 1 minute a couple of times a day
  • Body Weight squats holding ball between legs and squeeze the entire time. Do 10-15 a couple of times a day
  • Wrap a theraband tube or the wider band around a table leg or something stationary so that it can be placed right above your knee (I used my dining room table leg). Move away from anchor so have a good stretch in the band/tube. Slightly bend knee with the tube/band wrapped around leg right above top of knee. Then straighten knee and clench quad putting resistance on the band. Hold for 10 seconds. Do 10-15 a couple of times a day. Do both legs or just the bad one. Get a harder band/tube as it gets easier (and stand further away to stretch it out more).
  • Lay on floor with elbow under head. Top leg foot on floor in front of bottom leg for balance. Flex the bottom leg’s foot 90 degrees. Raise bottom leg up about 6 inches off floor and clench quad and hold for 10 seconds. Do 10-15 a couple of times a day. Do both legs or just the bad one.

The key is to fully get the knee extended on all the exercises where you are clenching the quad as that is what targets the VMO, as does the clenching of the ball on those exercises.

Hope that helps you!

14

I’m not a constant sufferer of runner’s knee, but every once in a while it pops up. Easily, the quickest and surest way for me to pass it by is frequent stretching. I have an office job, and try to make it a routine to bend-over/touch-toes to stretch out the hamstrings, and then some standing/one-leg quad stretches, after every time I return to my desk. Takes no longer than a minute each time; sure I get some odd looks sometimes, but its easily the most effective way for me to get rid of any discomfort.

15

I took almost 7 months completely off, maybe a short run here and there but that’s it.

Finally went away after 7 months, I run fine now but no speedwork at all!

16

Two ways to go or both, Cliff-note version:

  1. reduce knee flexion moment (torque)
  2. adapt internal structures to withstand large knee flexion moment or poor tracking

As you can see a differential diagnoses needs to happen of alignment verus loading problem (or both).

Ideas for #1

You may be running with a knee strategy as a compensation for weak or “non-firing” gluts, see a good running expert who can analyze your running and assist on form and exercise adjustments to get the hip more involved (with or without strengthening).

Footwear can reduce moments at the given segments ( hip, knee, or ankle), but overall impact does not change. Point is you may reduce knee flexion moment with lower ramp shoe, but it will come at the price of increased ankle moment. So know that going in.

Lose heel strike to get force closer to knee joint and reduce fexion moment (same precaution as footwear change)

Go to high cushion shoe ex. Hoka to attenuate some overall impact and reduce torques required at all joints

Ideas for #2

Anterior knee pain can be associated with poor rotational control of the hip (dynamic vagus) often a strength program with translational work with running can improve frontal and rotational plane movement at the knee and know-turn improve pain (especially try for PFPS).

strengthen gluts as per #1 but must learn to engage them

Strengthen calves in prep for lower ramp shoe with hopeful migration of foot strike to midfoot+

I didn’t speak to symptom management as it goes without saying, likely need to get some relief due to the chronic nature.

Pardon any grammar/typo’s, sending from iPad.

Cheers!

17

I took almost 7 months completely off, maybe a short run here and there but that’s it.

Finally went away after 7 months, I run fine now but no speedwork at all!

This.

I hurt my tendon by trying to run through knee pain 2.5 years ago to deal with some life stress (age 42, was running north of 50 mpw). Never had knee issues before. Saw reputable ortho right away, got MRI, was diagnosed with tendonitis/osis. Ortho told me to stop running, but I could ride as much as I’d like. I think that was bad advice (in my case; perhaps he didn’t realize how hard I like to ride :-). The pain didn’t start to subside until I stopped riding and running.

The trickiest thing for me has been the return to activity. I’ve learned through frustrating trial and error that I have to increase load on the tendon very gradually and very systematically. Doing too much can set the injury back A LOT (weeks or months). And it hasn’t always been training setbacks. A couple times simple play with the kids has required weeks to recover from.

By learning to listen to the signals the knee is giving me, I’ve finally been able to return to very hard cycling with no pain for a sustained period of time. But light hopping tells me it’s not ready to be run on, yet.

18

I took almost 7 months completely off, maybe a short run here and there but that’s it.

Finally went away after 7 months, I run fine now but no speedwork at all!

This.

I hurt my tendon by trying to run through knee pain 2.5 years ago to deal with some life stress (age 42, was running north of 50 mpw). Never had knee issues before. Saw reputable ortho right away, got MRI, was diagnosed with tendonitis/osis. Ortho told me to stop running, but I could ride as much as I’d like. I think that was bad advice (in my case; perhaps he didn’t realize how hard I like to ride :-). The pain didn’t start to subside until I stopped riding and running.

The trickiest thing for me has been the return to activity. I’ve learned through frustrating trial and error that I have to increase load on the tendon very gradually and very systematically. Doing too much can set the injury back A LOT (weeks or months). And it hasn’t always been training setbacks. A couple times simple play with the kids has required weeks to recover from.

By learning to listen to the signals the knee is giving me, I’ve finally been able to return to very hard cycling with no pain for a sustained period of time. But light hopping tells me it’s not ready to be run on, yet.

This sounds more like PT versus PFPS. If so, the methods for recovery tend to be different (at least that is what I have gleemed from my readings).

Cheers,
G

19

Two ways to go or both, Cliff-note version:

  1. reduce knee flexion moment (torque)
  2. adapt internal structures to withstand large knee flexion moment or poor tracking

As you can see a differential diagnoses needs to happen of alignment verus loading problem (or both).

Ideas for #1

You may be running with a knee strategy as a compensation for weak or “non-firing” gluts, see a good running expert who can analyze your running and assist on form and exercise adjustments to get the hip more involved (with or without strengthening).

Footwear can reduce moments at the given segments ( hip, knee, or ankle), but overall impact does not change. Point is you may reduce knee flexion moment with lower ramp shoe, but it will come at the price of increased ankle moment. So know that going in.

Lose heel strike to get force closer to knee joint and reduce fexion moment (same precaution as footwear change)

Go to high cushion shoe ex. Hoka to attenuate some overall impact and reduce torques required at all joints

Ideas for #2

Anterior knee pain can be associated with poor rotational control of the hip (dynamic vagus) often a strength program with translational work with running can improve frontal and rotational plane movement at the knee and know-turn improve pain (especially try for PFPS).

strengthen gluts as per #1 but must learn to engage them

Strengthen calves in prep for lower ramp shoe with hopeful migration of foot strike to midfoot+

I didn’t speak to symptom management as it goes without saying, likely need to get some relief due to the chronic nature.

Pardon any grammar/typo’s, sending from iPad.

Cheers!

Thanks KTM! (I used to ride a 450SXF)

I am a mid-foot to fore-foot striker (trained for it, and my PT confirms it through her video analysis of me running).

I tried Hokas, but they seemed to exacerbate the pain (seemed wobbly, unstable to me, my GF loves Hokas) and the shoes are sadly too narrow (tried the Bondi 3-supposedly their widest-2014 model shoe).

I do have an anatomical vagus condition. I can’t find a lot on the web about techniques for those with either an execessive varus or vagus anatomical build with regards to running technique. I will research more this dynamic vagus thing you mentioned.

Thanks!
G