View Vol. 1 Iss. 1
Orthopedics Magazine Articles


Twin Cities Knee Physicians:  

• John T. Anderson, M.D.
• Scott D. Anseth, M.D.
• Jonathan P. Asp, M.D.
• Paul M. Cammack, M.D.
• Robin C. Crandall, M.D.
• Paul R. Diekmann, M.D.
• Douglas A. Drake, M.D.
• Paul G. Dworak, M.D.
• Joseph Flake, M.D.
• Benjamin Gulli, M.D.
• Peter D. Holmberg, M.D.
• Neil R. Johnson, M.D.
• Cyril (Jay) F. Kruse, M.D.
• John R. Kearns, M.D.
• Desiree M. Kempcke, M.D.
• Patrick G. Kraft, M.D.
• Christopher M. Larson, M.D.
• William R. Lundberg, M.D.
• Jeffrey J. Mair, D.O.
• Christopher P. Meyer, M.D.
• Steven A. Moen, M.D.
• Thomas E. Nelson, M.D.
• Randall J. Norgard, M.D.
• Patrick F. O'Keefe, M.D.
• Brian T. O'Neill, M.D.
• Gavin T. Pittman, M.D.
• Thomas J. Raih, M.D.
• Kayvon S. Riggi, M.D.
• Gary R. Sager, M.D.
• J. Patrick Smith, M.D.
• Edward W. Szalapski, M.D.
• Robert W. Tuttle, M.D.
• Loren N. Vorlicky, M.D.
• Gary E. Wyard, M.D.

Out of Steam: Runner’s knee affects more than just athletes

Though dubbed “runner’s knee” because joggers and sprinters often suffer from pain under and around the kneecap, patellofemoral pain syndrome actually affects all types of athletes. So even if hitting the track is not your sport, this type of injury may still affect you.

What begins as a gradual onset of dull, achy pain in one knee, can also feel like the knee is giving way. Patients have also said that knee pain increases with prolonged sitting or when climbing the stairs, kneeling, squatting, or running up an incline.

Causes and precautions
Many doctors suspect that changes to the surface of the patella – the kneecap or bone at the front of the knee – cause the pain. Pain may also result from irritation to the tissue around the knee. While the precise mechanism of injury and pain remains unknown, several factors contribute to development of the condition. Overuse of the joint often leads to runner’s knee. In addition, the kneecap may be out of alignment; thigh muscles may be tight, out of balance, or weak; or the patient may have flat feet. Sometimes an injury will precipitate the pain.

To avoid runner’s knee, individuals should maintain a healthy weight. They should also warm up, and stretch before running or engaging in other physical activity. Runners should wear shoes with good shock absorption and train at a gradually increasing pace. They should also lean forward, keeping their knees bent as they run. Jogging on a smooth, resilient surface, such as a cushioned track rather than the road, is also a good idea, as is walking down steep hills or running downhill in a zigzag pattern to put less stress on the knee joint.

Diagnosis
When assessing runner’s knee, physicians inquire about the onset of symptoms, type of activities, and the types of running and playing surfaces. They perform a physical exam and watch how the patient walks, squats, sits, and moves. Often, individuals with runner’s knee favor the injured leg. Doctors also examine the knee and note any fluid or swelling; check joint alignment; evaluate muscle tone, strength, and flexibility; and assessfor tenderness when they touch or move the knee.

X-rays may be ordered to rule out other conditions such as arthritis. Doctors might also ask for a computed tomography (CT) or magnetic resonance imaging(MRI) scan to check for abnormalities.

Treatment
Treatment of runner’s knee aims to decrease pain and improve function. Initial therapy may involve elevating the knee, wrapping it in an elastic bandage, and applying cold packs several times a day to help decrease the pain and swelling. Physicians may have the patient tape the knee or wear a brace to support the joint. After the initial swelling goes down, doctors may suggest heat to relax muscles and increase blood flow. Alternating heat and cold can increase flexibility in a stiff joint. In addition, physicians may recommend a nonsteroidal anti-inflammatory medication. Once the pain and swelling decrease, doctors may also suggest a rehabilitation program to stretch and strengthen the supporting muscles and improve range of motion, agility, and coordination.

To aid in recovery, patients should avoid any activity that increases the pain until the action can be completed without discomfort. Patients may swim or try another low-impact activity instead of running or jumping until the problem resolves. Patients can participate in sports again once the injury heals and the doctor gives the go-ahead, but they should resume athletic pursuits gradually. It’s also important for runners to wear proper shoes to reduce or prevent knee pain. They can also place custom orthotics – or sometimes an off -the-shelf arch support – in their shoes to help relieve knee discomfort.

While most patients respond to conservative treatment with time, some cases may require surgery to remove debris from the knee or return the kneecap to proper alignment. Runner’s knee usually responds well to treatment and an active rehabilitation program. If athletes stick to sensible training schedules, wear supportive shoes, and use proper running technique, they can help alleviate the condition – and may even prevent its onset.