Runner’s Knee (Patellofemoral Pain Syndrome)

I am enjoying my vacation in Colorado with my family. We came out to attend and celebrate my nephew’s graduation from CU in Boulder. We went to the Denver Zoo today which was great as usual.

I have worked out a few times while I have been here at a gym in Castle Rock over the last few days and I was not able to shut my “work brain” off as usual. Lots to blog about from these workouts, but I will stick with Runner’s Knee (more recently called Patella Femoral Pain Syndrome or less recently Chondromalacia). My friends were running and biking indoors while I did my thing and I watched them as well as the other regulars at this gym. Endurance athletes and runners are a mess more often than not. It seems that the traditional information that they receive is helpful in the short term at best and crumby over the long term at the worst.

What is runner’s knee??

Wiki does s nice job with the definition if you are unfamiliar with this condition.

Another site I perused tonight listed the possible causes as;

  • Wide Hips (female runners)
  • Knock Knees (Genu Valgum)
  • Subluxating Patella
  • Patella Alta (high patella)
  • Small medial pole of patella or corresponding portion of femur
  • Weak Vastus Medialis
  • Weak Quadriceps Muscles
  • Tight Hamstrings or calf muscles
  • Pronation of the feet

Pronation of feet? What about the rest of the Kinetic Chain?? More on this later…

So another site listed some self treatment tips…

1)Stop running (yeah right…You tell this to a runner who can still walk!!!)

2) Take a course (5 – 7 days) of non-steroidal anti-inflammatory drugs(ibuprofen/voltaren/cataflam/mobic) available from your general practitioner or pharmacist (if you are in pain…then this can help with that symptom)

3) Apply ice to the shin area – for 10 minutes every 2 hours, in order to reduce the inflammation (not a bad idea…love ice for repetitive strain injuries)

4) Avoid weight-bearing activities and keep foot elevated where possible (again…good luck…)

5) Self-massage – using arnica oil or anti-inflammatory gel, on the sore spots around the knee (I like it to manage THE SYMPTOM!)

6) Stretch 2 – 3 times per day- the quadriceps, hamstring, iliotibial band (ITB) and gluteal muscles (….okay, why are we stretching the glutes to prevent over pronation…??? maybe trying to reduce pull on the ITB…but how about Myofascial rlease???)

7) Strengthen the quadriceps muscle only when pain-free.

Exercises include:

a) Place pillow under knee, tighten quadriceps, push knee down into pillow and lift foot up. 20 times (not horrible for VMO and articualris genu)

b) Repeat exercise as above with foot turned out in order to strengthen the inside of the quadriceps muscle. Repeat 20.
(not horrible for VMO)

c) Squats. Perform with back against wall. Bend knees slowly to between 45 – 60. Ensure that knee travels over line between bigand second toes. Hold for a count of 5 seconds. Relax slowly. 20 times (do this only if you want to continue quad dominance, like most runners, and continue to exclude the glutes from the picture)

d) Step-downs. Stand on step or box. Tighten quadriceps and lower opposite leg slowly to the ground.Ensure that knee travels over line and between big and second toes.Then raise the leg up onto the step,relax. Repeat 20. Increase the number of repetitions in increments of 5 every two days, all the way up to 60 reps. (okay if done correctly)

8) Return to running gradually (AMEN!)

Full recovery is usually between four to six weeks” (but what other symptom will show up next month??)


From a human movement standpoint, looking at the entire kinetic chain, obviously there is much more to this. To be brief let me just approach this with corrective exercise for the lower body.

With runner’s knee I see;

Over-Active Muscles

Under-Active Muscles

Calve complex

Tibialis anterior/posterior

Tensor fascia latte (TFL)

Gluteus medius


Gluteus maximus

Vastus lateralis

Intrinsic core stabilizers

Adductor magnus

Medial hamstrings/popliteus

Biceps femoris (short head

Soft tissue work, including self myofascial release (SMR) for the overactive muscles as well as the illio-tibial band (ITB) is the first place to start. A roller like the Rollaxer is an ideal tool or for true beginners who want to get more comfortable with a foam roller before committing to a high end tool try a 2.2lb density foam roll (can get just 1 of these, just click on it) from Perform Better. I say spend the $ now and get the Rollaxer…or at least a high density molded model.

SMR can pay instant dividends as it can help to eliminate trigger points and free up adhesions with in the connective tissue that envelopes the effected muscle fibers. Trigger points are points that are sore and tender with pressure and refer pain, numbness and tingling (as well as other sensations) to other parts of the body. Trigger points in the; TFL, ITB, Vastus lateralis and biceps femoris can refer pain to the knee and SMR techniques can provide instant relief from pain in the knee complex. SMR can also free up adhesion that may restrict joint movement and hamper function.

Static stretching for the; calves, hip flexor complex and biceps femoris will help return these muscles to their normal resting length allowing better range of motion at the hip, knee and ankle.

Activation techniques for the following muscles are next; tibialis anterior/posterior, glute medius, glute maximus, medial hamstring complex/popliteus and intrinsic core stabilizers. Making sure that these muscles can be stimulated by the nervous system and generate enough force to reduce, produce and stabilize movement is an important part of the corrective process.

The glutes especially help to stabilize the femur and decelerate pronation throughout the lower extremity. The posterior fibers of glute medius and glute max are particularly important.

Integration techniques help to reinforce coordinated movement patterns. Exercises like a squat to row or step up to curl to press can help groove coordination through the entire kinetic chain.

This of course a quick once over on the corrective exercise process, but I had to start somewhere.

The point is, look at human function, the 5 kinetic chain checkpoints (feet, knees, hips/pelvis/spine, shoulders, head) and address impairments that cause symptoms.

Address symptoms fine, but find the cause and address it now or be prepared for more pain in the same place or pain somewhere else later.

Thanks for reading!

Eric Beard

Athletic Performance Enhancement Specialist

Corrective Exercise Specialist

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This entry was posted in Eric Beard, injury prevention, injury rehabilitation, knee pain, patellafemoral pain syndrome, run faster, runner's knee, running shoes. Bookmark the permalink. Post a comment or leave a trackback: Trackback URL.

One Comment

  1. Muscles
    Posted May 13, 2009 at 11:31 am | Permalink

    A good medial post in the shoe also will help with the pronation. I know it doesn’t take the place of stretching/strengthening tight/weak muscles but it will jump start them back to running.

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