Help Me Fix My Runner’s Knee

Exercise is my Prozac. No exercise and I’m an unhappy homesteader. For years I’ve battled runner’s knee, known to the medical profession as patella femoral pain syndrome. Runner’s knee is caused by muscle imbalances in the upper leg that lead to the bones in the knee not tracking correctly. This results in a painful irritation to the kneecap. Running barefoot decreased the problem, but I was still afraid to push the mileage beyond short distances.

A foolish return to fencing, after a four year absence, is what tipped me back into severe knee pain. Fencing requires agility, strength and flexibility all of which I lack. And I really want to go back to fencing–martial arts are a great workout for mind, body and soul and I think participation in one is a valuable part of the homesteader’s fitness toolkit.

As least during this encounter with knee pain I have better doctors than I did the last time–a few years ago the diagnosis was arthritis (incorrect as it turns out) and the treatment consisted of a bottle of ibuprofen. Right now the orthopedist has asked me to:

  • take it easy for six weeks (gonna be hard but I’ll do it)
  • perform quad strengthening exercises with ankle weights
  • take Cosamin DS, a glucosamine and chondroitin supplement

My question to you, dear readers: what have you done to deal with runner’s knee and how is it going?

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44 Comments

  1. I feel for you! I was diagnosed with runners knee last winter when the rain took me off my bike and I walked more. Walked! After several doctor visits and an MRI to confirm no tears, my MD gave me these exercises:
    http://www.runnersworld.com/injury-treatment/stretching-and-strengthening-exercises-iliotibial-band-syndrome
    His advice was to stick with them a few times a week for six weeks, and then if the pain continued we’d re-evaluate the treatment. It took a few weeks for the exercises to kick in, but since then I’ve largely been pain free.
    The roller exercise? Total torture, but definitely one of the most useful ones. I skip the band exercise and the ball one, personally.
    Good luck!

  2. I was a dancer for 15 years and we have IT band issues all the time. The roller thing is beyond torture (there’s nothing like a roomful of dancers doing it – such colorful language!) but ultimately can be very useful. Another thing is that often weight bearing and weight assisted (eg ankle weights) exercises can be hard on knees. My father (a very well-muscled, athletic guy, mind you, so he was not given these exercises because he couldn’t handle something more “advanced”) had terrible knee pain that subsided only when he started doing his quad sets isometrically, seated, simply flexing the muscle and holding it contracted for 30 seconds at a time without letting it relax – focus on the vastis medialis which is usually the weakling and therefore the one allowing the knee to track badly. He used to keep his finger on the muscle to monitor it during the contraction, as often it would stop firing and without touching it my father wouldn’t have known, because the other 3 bigger guys were still going strong. Anyway, while he was doing those exercises, no knee pain. When he got lazy about them, knee pain came back.
    Good luck!

  3. I had the same problem and the way I solved it was doing a few simple exercises right before I go running that way the amount of prevention excise is alway balanced with the amount i run Im not allowed to go for my run until I do the exercises! which are: while sitting on the ground, three sets of 10 ten straight leg raises with a ten pound weight around my foot I use an old dumbbell weight with a leather belt through the hole and just loop my foot through the belt. i started with 5 pounds and slowly worked up to 15 pounds when I was running every day . if I skip the weights for a couple runs the condromalatia always comes back.
    also I turn my toe out a bit on each rep so i work the inside quad muscles a bit more. running develops the outside quad muscles more than the inside so this excess help the inside muscles keep up

  4. I fenced for fifteen years, which pretty much wrecked my front knee, but I’m still able to run daily. I’ve had bad knee pain off and on (not sure if it was runner’s knee) for years. I bought a bicycle to keep up my cardio while my knee healed.

  5. Hi,

    I can’t guarantee this will work for you, but I found the thinking interesting. I have some pain and swelling underneath the patella in one of my own knees, and during my research I ran into:

    http://savingmyknees.blogspot.com

    You can read an summary article by the author here:

    http://www.huffingtonpost.com/richard-bedard/knee-cartilage-repair_b_876946.html

    My primary take away is to be yet again reminded that our bodies are not static, and that nearly everything inside us is in constant flux – breaking down and building up. Cartilage apparently has some capacity to heal too, albeit at a lot slower rate than muscle. If nothing else, it’s something to keep in mind when you talk to your orthopedist, many of whom seem to believe that cartilage is purely ablative, and incapable of any kind of healing.

    Best of luck; physical ailments suck a lot of joy out of life. I’d love to be fencing again myself, but right now I’m just hoping for being able to hike a few miles without pain.

    Zeke

  6. Ask for physical therapy. That way you can’t squirrel out of doing the exercises you don’t like. Plus, they’ll make sure you’re doing it correctly.

  7. Kettlebell swings were the ticket for me. See a strongfirst or RKC certified instructor at least once to get form right.

  8. I don’t run distances but I am doing intervals on a hill 2-3 times per week, with crossfit workouts on 3 other days. My knees give me lots of pain going up and down stairs. My problem, so says my chiropractor, is quad muscles that are too tight. I stretch religiously and also ice about twice daily. I am 47, and I figure I am just gonna have to live with the pain. I am doing fish oil, and am about to start on the chondroitin stuff.

  9. For years I tried many, many different things on my “bad” knee, believing I could somehow control the pain. I tried different shoes, different activities, different medications and homeopathic remedies….I finally sought treatment from a renowned sports medicine/orthopedic surgeon (he specialized in treating hockey players, lol!), who trimmed my worn and torn medial meniscus in outpatient surgery. Problem solved. Completely. I can’t believe I suffered in pain for so long, thinking I was doing something wrong. So my advice is to see the best surgeon you can afford and understand that your problem may be beyond what you can control by your own actions. Today I’m hiking, biking and doing everything I want, and truly regret the years I was in pain trying to do those same things.

  10. Yoga can be really good to add into that, especially for runners. It helps a lot with knees, and yin, can help stretch it out properly to give some restorative qualities back to the tissues around it <3 Good luck!!!

  11. I have had 2 horrible bouts of “creaky knees” (some sites say this is the same as runner’s knee–I think health insurances pay less if they don’t say “runners knee”).

    The first time (age 23) I had to quit my second job shelving books at the public library. It was the deep knee bends that were the problem.

    Second bout (35 years old), the root problem was living in a 3rd floor apt. and carrying laundry to the ground floor, groceries up 2 flights, and a 3-year-old up and down the stairs. I had to take my 2nd riser out from step classes, then stop step entirely. I took kickboxing instead, weights classes, and some spin (be sure the bike is set up right!).

    Watch the supplements. Some are made from shellfish, and if shellfish don’t like you like they don’t like me (not allergic, just sensitive), watch out. 2 stupid pills took my digestive system 3 weeks to recover from!!! Never again.

    I have only recently taken up running (and still find it boring)–I worry about my knees constantly, but no issues yet.

  12. There are a lot of great answers already listed. Creating strength in the knee extensors (i.e, quads articularis genu) will create a giant sense of relief. Yoga will be great if, again, you are firing you front thigh because this will activate the law of reciprocal inhibition (you can google this rather than read my lengthy explanation). Having someone monitor your movement patterns (such as physical therapist, personal trainer) and correct them is also a huge piece of the puzzle to reinforce new found strength and resolving previous imbalances. The other thing I would add is to find a Muscle Activation Technique specialist (go to http://www.muscleactivation.com to find someone near you) to find ranges of motion in which you are unstable and and help the muscles to fire optimally so that this problem does not resurface somewhere else along the kinetic chain after you think you corrected the problem with some exercises you saw on YouTube. In short (ha, ha), the road to a healthy knee without surgery maybe a long and at arduous one, but judging by your blog, I think you can handle it!

  13. Thank you, thank you, thank you. I’m am so lucky to have a blog read by so many caring, helpful people. There’s a remarkable number of suggestions here–I’ve got a lot of options to ponder. And I wish you all good health and healthy knees in 2013!

  14. Some years ago I had knee problems and sorted them out with Feldenkrais therapy. Luckily there is a good practitioner not far from where I live in Cyprus. I am now dealing with frozen shoulder (a by-product of rotator cuff injury), and instead of turning to Feldenkrais at once, went the traditional route of surgery/physio — an experience which caused me to reframe my understanding of pain. I am now back with Feldenkrais, happier mentally and physically. I cannot recommend it enough for all sorts of human structural problems. Best of luck!

  15. I have the same problem. I don’t take medicines unless last resort. Last winter when my brother who 47 and never been sick got runners knee and was on crutches and /or walker I had him move in with me. I got him a bottle of Curamin PM and and some Red Algae both to take inflammation and pain away. After a few days he was walking on his own and was able to go back to work in a couple weeks. I have 10 acres I live off of in Missouri and would not be able to garden, take care of my chickens, cut trees in fence lines, keep greenhouse going, make my rock buildings (root cellar) and gardens. I am 59 and it has helped me. I believe you will find out it may help you. Curamin is made from the turmeric plant. It is what gives the seasoning curry it’s distinctive. yellow color. India and Asians use it for medical purposes besides food. I use both Curamin in day and Curamin PM to help keep pain away when I sleep. I hope this helps.

  16. Check out Danny Dreyer who teaches the posture elements of Chi Walking and running.
    1) pointing toes forward, helps take pressure off the knees.
    2) Leveling the pelvis (lifting it up to eliminate/minimize sway-back) also takes a different pressure off knees.
    3) Life and elongate neck, holding body upright, yet shoulders slightly forward of ankles, will let gravity help legs move forward, rather than having to push them forward.
    This is congruent with the Mensendieck methods
    1) Feet closer together, Rest on Balls of feet, not heels to tilt slightly forward, and unlock your knees
    2) pull buttocks together and bring rear under (like tilting pelvis up in-front) and contract vertical abdominal muscles – to hold up your stomach, not in and breastbone high
    4) pull shoulder blades together and down a bit in back, chin parallel to floor

    • Chi-running is exactly what I was going to suggest – one of the best bits of advice I took from the beginning was to be conscience about pointing your feet in the direction you wanted to go (tip #1). I honestly haven’t had a knee problem since and it has been over two years.

    • Great suggestion–I lost my shoes about three years ago and it really helped with the knees. This time around the problem is fencing which puts a lot more stress on the knees than running does. But the problem could also be related to shoes. I was fencing in tennis shoes and may need to invest in fencing shoes (which are minimalist and more like being barefoot).

  17. I tore my meniscus last April (running off our deck Rambo-style to fend off our rooster who was flying in my daughter’s face . . . ) which led to surgery. The pain and swelling did not subside until I started doing knee strengthening exercises and stair climbing. The upwards motion of stair climbing, as opposed to the lateral motion of walking or running, combined with pilates-type exercises (strengthening and stretching) rebuilt the muscles around my knee which stabilized it during normal movement. This helped lower inflammation and allowed my body to heal the injured area. I also take Krill oil, vitamin D and consume a lot of turmeric.

  18. Have you seen those white cylindrical rollers made of styrofoam about 6″ diameter and 18-26″ long? The best therapy for this syndrome bar none is to lie face down on the roller, leaning on your arms for support, and rolling your quads out. Don’t be surprised if the first time you try it it hurts a lot; that is an indication of how tight your quads are even at rest. But you will notice immediate release of the muscles in your knees. Regular use of the roller will release the strong pull of quads on the knee joint and allow inflammation to heal and the muscles to realign more functionally. I don’t know why orthopedists don’t recommend this more often. It was a Pilates Rehab therapist who taught me, and I am forever grateful. Good Luck to you!

  19. I had that exact pain, followed that exact treatment, and it helped. (I think I may also have iced the kneecap for a bit at the beginning, too.)

    What moved me from “having bad knees” to “having healthy knees” was taking up indoor rock climbing. So I think there’s something to the “strengthen your quads” route. If you don’t want to do that, maybe yoga or tai chi would help?

  20. Quad-strengthening exercises made all the difference for me. The most effective one, actually, was sitting in a chair, holding the leg out straight, and tensing the thigh muscles repeatedly. It’s those last couple of degrees of extension that are the most important for strengthening the muscles that hold the patella in the correct position, so this fairly passive exercise can make a big difference.

  21. Where to start…
    Please don’t take this as a “come on” or solicitation for biz. I’ve enjoyed your website for years and thought I might have something to contribute here. I taught ChiRunning for 7 years and now have my own “style” called Effortless Running. Please take the following for what it’s worth…

    When running you’re always dealing with two major forces (at least). The two forces are gravity and braking forces. Gravity is pretty straight forward and probably doesn’t require any explanation. Braking forces are what YOU generate when you move forward. For example, let’s say you want to run from your front door across the street (we’ll pretend it’s a level, straight shot and there’s no traffic). If you run at a 10 minute mile pace you will generate a braking force of 6 mph. The braking force is the force that’s “coming at you” as you’re moving forward. It’s a fact of nature… if you move in a given direction you’ll generate a braking force — there’s nothing you can do about it.

    Ahh… but you CAN cooperate with it. Read on.

    Let’s say you’re a heel striker/overstrider and you swing your foot out in front of your body weight. That means when your foot hits the ground in front of you it stops (brakes) but the rest of you continues to move forward. Now all the shock from that foot placement (remember it’s in front of your body weight) goes up the kinetic chain and affects all the body mass and joints still (through momentum) moving forward. So your ankle joint, knee joint, hip joint and all the vertebrae in your back experience braking and shearing forces. What ever is the weakest link in the kinetic chain will, eventually “break.” This is not what would be commonly thought of as optimal for a long term pain free running career.

    However, if you were able to get your foot to land under (or close to under) your body weight, and as it landed, and so move in the same direction as the braking force then you’d be maximizing your forward momentum while minimizing any injury due to braking forces.

    In the first example you would be meeting a force (braking force) with another force (the forward momentum of your foot crashing into the braking force as it landed in front of your body)… Mayhem ensues.

    In the second example you’d be cooperating with the braking force by having your foot moving in the same direction as the braking force — thereby redirecting your force behind you (and out of harm’s way), much like a martial artist — to negate the braking force.

    What you’re actually doing is best seen in high speed video. Once you can see what you’re doing you can then get a sense of the corrections required (a coach may be helpful here) to help you move forward and enjoy more pain free, effortless running.

    Hope that helps. If what I wrote is unclear or misleading please contact me. I’d be happy to help you get back on track.

    Best,
    Ben

    • Thanks Ben for your input. I completely agree about the vital importance of form in running. The irony with my current case of runner’s knee is that it was caused by fencing, a sport where form is what you work on–the exact angle at which you hold the blade, the depth of your lunge, half-lunge, etc. With running, hardly anyone gets a lesson in form before heading out–runners should, of course, as I’m sure you would agree. I had been struggling with my running form for the past three years before finally getting rid of my heel striking habit. When I go back to fencing I’m going to take some private lessons to make sure that my footwork is efficient and knees are aligned properly. That and the strengthening and roller stretches other people have suggested, I hope, will take care of the problem. But I’m sure I could use a few pointers in running too–thanks for your offer to help.

    • Ben,
      Are you still teaching running techniques?

      I am in the Army and would like to talk to you about instructing.

      Please reply at your earliest convenience.
      Thank you

  22. There are so many great ideas here! Foam roller is super painful, but absolutely necessary. Have you ever tried acupuncture? It can be quite helpful for reducing pain and inflammation and there are tons of good acupuncturists in the LA area.

  23. I struggled with this when I first ran more than three miles. I got custom orthotics and the problem went away completely. Since then I have run six marathons. The only times I have ever experienced runner’s knee since were on long hiking and cycling trips when I forgot to use the orthotics from my sneakers in my hiking boots or cycling shoes.

  24. So Orthotics are any device, arch-support or insole that changes the function and biomechanics of the foot, thus improving the knee by:
    . Improving the distribution of force through the foot and ankle which impacts the knee.
    . Cushions/reduces impact to knee if your weight balance is too far back on heel rather toward balls of feet.
    . Improves alignment at the knee by minimizing over-pronation (rolling in) of the foot, which can result in patellofemoral pain, iliotibial band syndrome or make the pain from some types of osteoarthritis worse.
    http://www.kneepaininfo.com/orthoticspatellofem.html

    • I have to say I’m not a fan of orthotics. I can speak only for myself, but I got rid of a case of plantar fasciitis by ditching support and going barefoot. I tend to think that supports may work short term, but they lead to weakening of of muscles long term. At least that was my experience.

  25. Glad to hear that – balance, tone and strengthen ourselves by understanding and using our given natural design – simple yet sophisticated.
    We did not come with operating instructions.

  26. Comfrey! I had torn my ACL and was in a great deal of pain and could not afford surgery. A woman living nearby heard of my plight which reminded her of her football player son and what they had to do for him in the past with his injuries. She wrapped my leg in hot towels that had been soaking in Comfrey which she had cut up finely yet picked fresh that day. She had me drink the tea while my skin absorbed the comfrey. My knee healed quickly and i was off crutches by the next week.

  27. This is crazy! I’ve had runners knee and I have tried everything! I can say it has improved a lot and now I can do my daily routines, something I had to stop doing for a while! All the comments and information is great! I’m posting up a link to this website that I just found and specifically to an article to this specific topic that gave me a lot of information and would like to also share with you guys. Hey the more help and information the better! Hope you guys enjoy.

    http://teamdoctorsblog.com/2012/05/25/cracking-achy-knee-pain-or-chondromalacia-patella-treatment-and-prevention-tips-from-the-barefoot-running-doctor/

    • Thanks Robert–a friend of mine is a big fan of Mobilitywod–I’m going to take a look at it and give it a try.

  28. Pingback: Easing the Pain of Runner’s Knee | Root Simple

  29. I hope I’m not too slow with my comment — just catching up on the blog! I suffered with knee pain for about 15 years and tried all sorts of things, including yoga, decreasing my mileage, physical therapy, and even orthroscopic surgery. Nothing helped. After being diagnosed with food allergies and an autoimmune gluten intolerance in my early 30s, I changed my diet and my joint pain vanished almost overnight. Avoiding gluten and nightshades were what made the difference for me. If I could shout this message from the rooftops I literally would — being pain free is such a blessing, especially being able to RUN pain free!! I can eat a few small servings of nightshades a week now but any more than that and my joint pain flares up. Hope you find a solution that works, whatever it is.

  30. In runners, its a big disappointment to have patellofemoral pain syndrome. I second with Peter Eller, about having a right kind of exercise before you go for a race. Stretching exercises will surely help out. I also refer to Runnersworld Runner’s knee guidance at http://www.runnersworld.com/tag/runners-knee which will be helpful to many other runners as well.

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