A Champion's Guide to Runner's Knee: Causes, Treatments, Prevention

If you suffer from runner's knee, then you're in the right place:

Runner’s knee is a very painful condition. It is prevalent among athletes who are prone to frequent knee flexing activities such as running, cycling etc.

However, there are many misconceptions attached to this condition and I will attempt to guide you clearly, with everything you should know about runner’s knee.

If you are one of those affected by this injury, or have been in the past, you would know, it causes a painful sensation around the kneecap area which makes it difficult or impossible for anyone to conduct any activity that involves bending the knees.

Now without further ado, let’s dive in…

What is Runner's Knee?

Here’s an interesting titbit of information that the majority of people are unaware of:

Runner’s knee is simply the effect of an underlying condition, that is, it is not an ailment in itself, but is a condition that occurs when affected by certain injuries/syndromes.

Runner’s knee can be caused by any one of the following (multiple if you are disastrously unlucky):

  • Iliotibial Band Syndrome or ITBS – The thick band of fascia (a sheet of connective tissue) on the side of the knee that extends from the pelvic area, around the hip and knee, ending just below the knee, is called the Iliotibial Band. This band is crucial in providing us with stability as we run, it moves in front and behind the femur (thigh bone) repeatedly, thereby, stabilizing us. Overexertion causes this band to rub on the side of the femur repeatedly, this prolonged action results in inflammation of the band which in turn causes the pain that you associate with runner’s knee (Source).
  • Patellofemoral Syndrome or PFPS – The knee consists of 3 parts, first is the femur or thigh bone, second the shin bone or the tibia and lastly, the kneecap also called the patella. The femur and the kneecap form the joint called the Patellofemoral Joint, this joint is what the second type of runner’s knee affects. It is caused due to repetitive compressive and shearing forces on the aforementioned joint (Source). PFPS can be caused by reasons like overuse, excess weight, injury or misaligned kneecaps.
  • Chondromalacia Patellae or CMP – Though often confused with the Patellofemoral Syndrome, Chondromalacia patellae has been medically established to be a separate but somewhat similar condition affecting the knee. The general consensus is that a damaged patellar articular cartilage signifies a person is suffering from CMP (Source) rather than PFPS which is caused by repetitive and prolonged stress on the patellofemoral joint. The main causes of this condition are direct and acute trauma to the kneecap or patella and friction between the kneecap and a groove in the thigh bone (femur) through which it needs to pass, in order to carry out a successful knee flex.
  • Plica Syndrome or Synovial Plica Syndrome – The final condition that may lead to a runner’s knee is the Plica syndrome. A plica is an addendum of the protective Synovial capsule, which is a fibrous covering of a Synovial joint. The inflammation in this condition occurs if the plica is caught on the femur (thigh bone) or gets trapped between the femur and the kneecap (Source). Plica, generally do not cause any medical issues other than this condition which happens when the synovial capsule is irritated, consequently, enlarging the plica which might result in inflammation.

Fortunately, there is a straightforward approach to finding out what type of runner’s knee is causing that shooting pain in your knees every time you try and run.

If the pain you experience, seems to be centered around the side of your knee, you can be certain that it is the Iliotibial Band syndrome that is causing the pain.

On the other hand, if the pain seems to be based right under your kneecap, Patellofemoral syndrome is bound to be the culprit.

Plica syndrome and Chondromalacia Patellae can be detected by any imaging scan like the MRI, additionally, people suffering from Chondromalacia Patellae will feel a grinding sensation during knee flexion.

Here’s the deal:

All this might sound very medical and advanced, and it is, but it is also essential that you diagnose and understand what type of injury affects your knee otherwise you will not be able to follow up with an appropriate method of treatment.

Runner’s knee is one of the most misdiagnosed ailments in the world due to the fact that people do not know the different types that exist and they end up following a remedy to one type while they might be affected by another type.

All the dire, doom-spelling medical mumbo-jumbo comes to an end, and now:

I will go about explaining how to treat runner’s knee effectively. Incorrect treatment of this condition can lead to several months of delay in your recovery process.

Which Treatment for Runner's Knee?

Check this out! Based on the type of runner's knee pain you experience, here are the 4 types of treatments you should follow.

Iliotibial BandPatellofemoralChondromalaciaPlica

Treatment for Iliotibial Band Syndrome or ITBS type Runner’s Knee

Since ITBS affects the Iliotibial band, the best strategy to treat this condition is regular and gradual bolstering of the muscles that control the rotation of the thigh muscle or femur, the position of the pelvis and ensure the Iliotibial Band is not compressed or stretched away from the hip region.

The aforementioned muscles are the hips and the glutes, strengthening these will go a long way in treating ITBS and dumping the pain and inconvenience as soon as humanly possible. There are 3 steps involved in the treatment of this type of runner’s knee (Several medical studies like this one prove the effectiveness of this treatment):

  • Step 1 – Managing/Controlling the Inflammation

It is essential that you do not continue overexertion of your knee if you are affected by this condition (sounds obvious, but too many people ignore this).

The best ways to control the inflammation that causes the pain linked to runner’s knee or ITBS are ice packs, rest and non-steroidal anti-inflammatory drugs.

If the inflammation is so severe that it is restricting even basic movement, corticosteroid injections are an option that will help alleviate the swelling.

Please keep in mind that managing the inflammation alone does not cure your runner’s knee condition in any way, it simply paves the way for the actual treatment to begin.

  • Step 2 – Massages

runners knee massageNow that the inflammation has subsided and the pain has considerably reduced, deep tissue massages are the way to go. This helps relax and toughen the previously inflamed band, muscles and tissues.

The massage also helps in relieving the tension present in the tendon due to your condition.

Though it is recommended to get a massage from a certified professional, you can work with foam rollers if your budget doesn’t allow you the luxury of the former. This stage assists in preparing for the final step in the treatment of ITBS.

  • Step 3 – Bolstering the Band and Nearby Areas

Several studies have shown that strengthening the glutes and hips is the best treatment for ITBS.

However, this is not possible to achieve with an inflamed knee, thus the steps 1 and 2. A therapy band (rubber tubing) is recommended to carry out the exercises required to alleviate the ITBS condition.

I have listed 3 simple exercises, that help in this process, below:

1- Raise your legs to the side at an angle of 45 degrees.

Repeat this around 20 times or less if you start experiencing pain. Another version of this is performing the same action while adding the therapy band to the ankles to provide an increased resistance in this activity. However, the second version should be started only after the pain from the inflammation has completely subsided.

2- The clamshell is a well-known exercise which strengthens the hips and the glutes.

It consists of lying down on your side, with legs folded at 90 degrees in front of you. Now proceed to lift the upper leg and bring it back down. Repeat this action 20 times or until pain kicks in. Use the therapy band between your thighs to add resistance to this exercise.

3- Side Shuffle is another popular exercise that helps in bolstering the areas affected by ITBS, the process is as follows:

Bend your knees to achieve a half squat position, now shuffle to the side in 10 steps, stop and shuffle to the other side for 10 steps. Repeat this 3-4 times or until you start experiencing discomfort.

Treatment for Patellofemoral Syndrome or PFPS type Runner’s Knee

Since the Patellofemoral pain syndrome (PFPS) affects the knee itself unlike Iliotibial Band Syndrome (ITBS), rather than the band that passes through it, the treatment procedures for managing this cause of runner’s knee tends to differ from the ones for ITBS (Source).

90% of people suffering from PFPS recover fully without requiring any surgical procedure whatsoever, so that should make you feel slightly better if you are one of those affected by runner’s knee due to PFPS.

  • The treatment begins with avoiding any activity that requires the knee to be bent for a prolonged period of time. Activities like squatting, kneeling should be completely avoided in order to avert further worsening of the runner’s knee condition.
  • Physical therapy is the next step in the treatment of PFPS, usually lasting 6-12 months, depending on the severity of your condition. This can be replaced by exercises at your home, but it is still recommended to get the help of a professional, especially since any further injury to your knees might have disastrous consequences.
  • While the treatment of ITBS concentrates on strengthening the hips and glutes in your body, people suffering from PFPS should focus on movements that strengthen the hamstring, knee and your calf muscles. The patellofemoral joint is the crux of the problem and thus, it needs to go through tightening and revitalization before it can function normally again.

Treatment for Chondromalacia Patellae or CMP type Runner’s Knee

Chondromalacia Patellae is the condition that is caused due to damaged or worn out articular cartilage, hence treating this injury/situation has two approaches (Source):

  • The non-surgical method is the first approach for treatment of this case of runner’s knee:
    • First, the pressure that is being applied on your kneecap and joint should be controlled by using ice packs, stabilizing the affected area and giving it complete rest.
    • This is followed by prescription of anti-inflammatory tablets that will assist in managing the swelling and reducing pressure on the knee joint.
    • In some cases, the first two steps are enough for a full recovery, however in severe cases, physical therapy is also required. Therapy should focus on rejuvenating your quadriceps and hamstrings, this improves muscle balance which in turn alleviates the danger of knee malalignment.
  • In cases of Chondromalacia Patellae that arise due to birth defects, a surgery is the only method of preventing it from occurring repeatedly. The birth defect in question is knee misalignment, a micro camera is inserted into the knee using a tiny incision to check for this defect and verify the need for a surgery. The best solution for this defect is called a lateral release, which involves disconnecting some ligaments to release pressure from the joint and allow free movement of the knee joint.

Treatment for Plica Syndrome or Synovial Plica Syndrome type Runner’s Knee

Plica syndrome in a majority of cases corrects itself after providing you with a brief stint of pain and discomfort in your knee. Hence, managing the swelling that occurs due to this syndrome is paramount. Resolving runner’s knee caused by the Plica syndrome can be done by 2 methods (Source):

  • The non-surgical method involves simply trying to diminish the pain and inflammation. The common methods proven to help with this are:
    • ice packs or ice massages are a massive help in reducing the swelling if they are used on the affected area repeatedly until the inflammation subsides.
    • anti-inflammatory medicines are another option which will also manage any pain that you may be experiencing, ibuprofen is an example of such a medicine, but these medicines should be taken only if a doctor prescribes them.
    • cortisone injections on the affected area to help bring down the swelling rapidly and should be used if recommended by a healthcare professional.
  • The surgical method involves removing the plica completely. Since this is an appendage, and does not have any function in the body, you will not miss the absence of this guy. The surgery is performed using Arthroscopy, similar to treating CMP, but instead of cutting ligaments, the plica is cut away in this case.

This is crazy:

Dealing with a knee injury is no walk in the park. The constant pain, the inconvenience, the inability to get up and about and giving up doing what you love (running, jogging, yoga, cycling etc.) for long periods of time is enough to get on anyone’s nerves. Hence, it is crucial that this injury be sorted out as quickly as possible, so you can resume your normal routine.

The recovery for a person affected by runner’s knee depends on a number of factors such as severity of the damage, correct diagnosis of the cause, prompt treatment etc. The healing process could be anywhere between a few days for mild cases, and up to a year for severe cases.

Prevention of Runner’s Knee

Now that I have gone over all the scary stuff involving needles, ice, and surgery to treat runner’s knee, you might be thinking: ‘OK, you’ve successfully scared me, now tell me how to prevent this from ever happening to me’. Don’t fret as I have compiled the best ways to minimize the chance of ending up with a runner’s knee condition.

  • Strengthening the muscles and body regions involved in the knee flexion is one of the most important ways to minimize the possibility of runner’s knee. The areas to concentrate on are the hips, thighs, hamstrings and quadriceps. There are multiple exercises that can be carried out in the comfort of your backyard or even your living strength trainingroom with a mat, to strengthen these areas of your body before performing activities that strain the knee. Balancing the muscles is critical in preventing runner’s knee as over-developed muscles at one portion and weak muscles on the other will cause instability in the motion of knee bending, which greatly increases the chance of ending up with a runner’s knee. Some exercises that will help in strengthening your muscles are listed below:
    • Single leg squats are essential in enhancing your gluteus which is the muscle that is used when you extend your hips (procedure).
    • A low lunge is helpful in flexing all the muscles in your hips and legs, this exercise covers a wide range of motion that helps the body get acquainted with this movement (procedure).
    • Side lunge helps in flexing the gluteus medius which is found to be weak in runners but it is crucial that it be strengthened to avoid the runner’s knee condition (procedure).
  • Stretching is one of the key ways of preventing runner’s knee that occurs due to iliotibial band syndrome. The tightening or swelling of this band causes a distinctive pain on the side of the knee, this is due to the band causing the single leg squatkneecap to move unnaturally. Stretching that concentrates on the hips and the femur bones are the best methods of keeping this band from inflammation. Stretching using our own muscles will not assist in this regard and the use of foam rollers or massages is recommended. You might experience slight discomfort at first if you have a tight iliotibial band and had never realized it, but this will ease over time and you will notice the difference. Some common stretches that are known to help prevent runner’s knee are:
    • Hip Stretches
    • Hamstring Stretches
    • Calf Stretches
    • Standing Stretches
  • Correcting gait is another crucial method of avoiding runner’s knee, as continuous, regular movement that is improper will result in the kneecap sliding over the joint at unnatural angles. Over striding is one of the most common runners kneeways of people having incorrect gait, this places an inordinate amount of strain on the knee and continuing this strain has a major impact on your knee (joint and kneecap) which is a sure path to ending up with a runner’s knee. Correcting your gait consists of detecting the problem with your posture or stride and making a conscious effort to improve on the said problem. There are no medical methods to help with this issue, and is in your hands completely.
  • Avoiding overexertion is sort of obvious but crucial if you are looking to avoid the dreaded runner’s knee condition. Training should be a gradual step by step process as the tissues in the concerned area get damaged when you train them and flex them over and over again. It is important to follow a proper regimen that does not take a toll on your body, especially those knees. Trust me, training will be a lot slower if you end up with a runner’s knee by trying to speed through training and increasing it to a pace you cannot handle all of a sudden. Always take breaks and try to leave open a day per week for rest, the body will adapt to the strain faster and you will be minimizing the chances of getting affected by runner’s knee.

It’s time for a reality check unfortunately. These prevention measures will have very insignificant impact on those who have physical defects, either from birth or through trauma. Some form of treatment is inevitable for people having defects in their knees as no exercise can cure these conditions (till date).

Tools to Help Cure and Prevent Runner’s Knee

Here's the best part:

There are several products in the market that claim to make a difference in the recovery speed of those affected by runner’s knee and minimizing the risk of getting affected by it.

The majority of the products that claim to perform magic on your knee and instantly heal it are bound to be driven by marketing gimmicks and misinformation.

I stripped away all the fluff from these tools and found two that seem to actually work and have several studies supporting their claim that, use of their product has a significant impact on both the rate of runner’s knee injuries and recovery time of those already affected by the condition.

Bodhivana 2-in-1 Foam Roller High Density Trigger Point Deep Tissue Massage Foam Rollers for MusclesFrequent running/cycling etc. cause the muscles to damage and repair frequently to accommodate the new levels of stress being applied to them.

Prolonged exertion, however, leads to the muscle becoming tight due to the tightening of the connective tissue to protect muscles from further breakdown. This causes the formation of knots in the muscles in specific areas, these knots can be identified by running your hand over the affected area, the spot should feel tight and balled up.

Foam rollers are often used by athletes and trainers to help in strengthening and inhibiting muscles that are overworked and overexerted over the course of training and sports.

The technique employed by foam rolling is called a self-myofascial release, it is proven to help substantially when it comes to people suffering from runner’s knee and people who overexert those muscles and wish to avoid the pain and inconvenience of suffering from the condition in the future.

The quality of the foam roller is critical since a wrong density or build can have the opposite effect on your body and may end up causing damage instead of rehabilitating your knee and/or muscles. The use of a foam roller is one of the best ways to repair muscle knots.

 Here is how to use one correctly:

  • Use the roller across the affected area for a minute by rolling back and forth.
  • Figure out where the muscle knot is and apply the roller to the area for a longer period of time.
  • Avoid using the foam roller on areas that will cause bones to undergo excess pressure.
  • Never use a foam roller on the part of the body that is inflamed as this will only aggravate the inflammation.

Selecting the right foam roller is crucial and I went over a few options in the market, but the one of the few products that offered reliability and also had several professionals backing it, was the Bodhivana Foam Roller.

The product is well-balanced and provides a uniform density and applies only the required pressure on the muscles, thereby, strengthening them. It has an added advantage of having long lasting foam, this means that your roller will not disintegrate into shreds with a few months of use.

runners knee braceBraces are a different kind of product, they do not offer rehabilitation to already injured muscles, instead they offer support to these muscles while you are performing strenuous activities.

Studies have shown that compression sleeves and patella straps do help in reducing pressure on the knees while allowing the user to maintain the same level of performance as without the brace.

The compression sleeve has two major uses, first, it provides compression to the knee and surrounding areas and secondly, it keeps the brain informed that the knee might need some extra support during the activity being performed, that will keep the body aware of this fact.

Patella straps on the other hand, assist the kneecap in maintaining proper motion during knee flexion, as nature intended. Correcting the warunners knee bracey your kneecap goes a long way in preventing runner’s knee and using these straps have been known to be beneficial too.

Selecting an appropriate brace is also critical since a wrong choice would lead to damage, instead of the support that you were expecting. There are numerous options in the market which promise to magically heal everything to do with your knees, so I set about to do some research. I found that the majority of the products in the market did not work, or they had several issues attached to them, consequently, making their use a downright nuisance. The major problems I witnessed with some popular brands are – sliding down the knee while exercising, providing too much compression, which causes damage to an inflamed knee or providing little to no compression that does not help the knee in any way.

That's why at WIMI Sports & Fitness we offer a complete solution: a Compression Knee Sleeve + Double Patella Strap.

This knee system provides the optimal level of compression needed to support your knee and has an adjustable double patella strap that does not slide down to your ankles or change positions at the slightest pretext.

Final Words

I have tried to cover everything pertaining to the runner’s knee condition and reading this guide should be enough to prevent runner’s knee or treating it and getting back on your feet faster.

Please note that this is in no way a substitute for the advice or recommendations of a healthcare professional. The methods of treatments, preventive measures and tools to help you do so have been medically proven to help with this condition and the studies/papers linked will provide a more authoritative source on the claims I have made (like this and this).

Consider having a physical therapist on payroll if you are involved in performing activities that overexert your knees and body in general, trust me, there is no replacement to the value that a professional can add to your training regimen.


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Product images sourced from Amazon.com.