Posts Tagged ‘runner’s knee’

This is the third post in the knee pain series.  Part 1 started with a quick anatomy overview of the knee.  I then moved on to the most common type of knee pain- lateral knee pain.  Anterior knee pain is the second most common knee injury I see in the clinic.  As the image below demonstrates, anterior knee pain (in red) can include the area above or below the kneecap, under the kneecap, or any combination of these.  Medial knee pain (in green) is usually the inner edge of the knee and can be a little above or below the actual joint line.

anterior knee pain

sites of medial & anterior knee pain

This is where internet diagnosing becomes more problematic.  So let me start by saying that what follows is most appropriate for runners who have not had an “event” like falling, tripping, hitting your knee etc. that resulted in immediate knee pain with swelling and/or bruising.  Additionally, if your knee has a painful click, pop, locking sensation, feeling of instability, or other feeling that’s “not right” – you should go to have your knee looked at by a physical therapist or other knee specialist.  Those symptoms are the signs of something more significant like a meniscus or ligament injury.  Knees that pop, click etc. without pain are typically not something to be concerned about.

Whenever someone describes knee pain located above or around their kneecap, I immediately become suspicious of this person’s quad flexibility.  A tight quad will lead to improper patella tracking and eventually pain.  When the subject of patella tracking issues come up, it’s common to hear medical professionals recommend strengthening the vastus medialis oblique (VMO) muscle.  This is outdated information.  Unfortunately, there are still websites and people that give this advice.  While you won’t hurt anything or make the problem worse by doing these exercises, there are more effective strategies to correct this type of knee pain.

The first thing I have people do is work on stretching their quads.  By that I mean REALLY stretching their quads- not just grabbing their foot and bending their knee for a few seconds.  I recommend the following “lunge stretch”.  It focuses on the quads and hip flexors.  There are two versions to this stretch.  If you’re not very flexible, start with the left image.  Once you begin noticing some improvements, you can try the more advanced version on the right.

  • Begin by kneeling on a knee-friendly surface next to something that can be used as upper body support, preferably something on both sides
  • The opposite leg goes forward in a lunge position, arms/hands holding on to a stable surface allows your lower body to relax more
  • Keeping your head up, torso upright and hips facing forward, slowly move your hips forward and down until you feel a stretch along the front of your thigh of the kneeling leg
  • HERE IS THE IMPORTANT PART!  Hold this stretched position for 30-45 seconds.  Yes, it seems like forever.
  • Repeat other side then alternate back and forth three times each side
  • To make the stretch more intense, grab your foot or shoe and slowly bring your foot up toward your hip


Shortly after stretching has been incorporated into a person’s daily routine, the next step is to begin strengthening the running specific muscles.  Again, refer to Knee Pain Part 2 for descriptions of these exercises.  The above stretch, combined with hip and hamstring strengthening has helped many people.  If this stretch does not seem to help within a couple weeks of consistent effort, seek help from a medical professional.  As always, please send any questions along to me if anything is unclear.  Good luck!!

***This blog is intended for information purposes only.  It is not intended to diagnose or treat any injury.  Please consult with your doctor or physical therapist if you have any knee pain and prior to beginning any exercises or treatment plan on yourself or others.

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“Knee pain” – it seems like those words are as common in the running community as “running shoes.”  It’s a frustration of so many runners.  Many people go online trying to self-diagnose the nagging knee pain they’ve had only to conclude that they need a full surgical knee replacement.  There are many, many factors that affect why/how someone’s knee hurts.  Obviously, there will be exceptional situations, but in my next few posts, I’ll do my best to discuss the most common causes of knee pain related to running and what to do about it.  First, calm down, it’s very likely that you do NOT need a knee replacement.  Second, a quick anatomy lesson…

The knee joint is unique in that it sits out there in space between two relatively stable joints – the hip and the ankle.  The hip has the pelvis and core to help stabilize it and the ankle is stabilized by the foot and ground.  You cannot move the hip or ankle without it affecting the knee to some degree (this is important because hip weakness is a common source of knee pain… stay tuned).  The big bone of our thigh is the femur; the big bone of the lower leg is the tibia.  The knee is where these two bones meet and glide over each other.  The patella (kneecap) glides in a track over the end of the femur when the knee is bending.  The smaller bone on the outside of the lower leg is the fibula, it’s sometimes considered part of the knee.

Bones of the knee

Bones of the knee

On the back (posterior) of the knee, our gastrocnemius (calf muscle) attaches to the femur – above the joint line.  The three hamstring muscles – biceps femoris attaches to the fibula, semi membranosis & semi tendonosis attach to the tibia – below the joint line.

posterior muscles

In the front of the knee, the four quadriceps muscles converge to form the patella tendon and also attach on the tibia, the kneecap sits inside that tendon (see small image).  The

patella tendon

patella tendon

sartorius muscle attaches on the medial side of the knee on the tibia, (push your knees together, where they hit is the medial side, where your hands are pushing is lateral).

anterior muscles

Lastly, the iliotibial band (ITB), which is really a long tendon, attaches on the lateral side of the knee on the tibia.  And then there’s the medial & lateral meniscus and a whole bunch of ligaments and other structures that help reinforce the knee… like I said, quick lesson.

How did your knee start hurting?  That’s the first question I always ask people.  This starts the dichotomy toward the proper steps of fixing the problem.  With runners, the most typical answer is: “I don’t know.  It started as a slight pain that I thought would go away but it has just been getting worse.”  They usually continue by saying: “at first it hurt toward the end of my run, then it slowly started hurting earlier during runs, now my knee hurts the next day, stairs are painful to walk down“, etc.  Believe it or not, that’s actually not difficult to fix, I’ll explain how and why soon.

The not-so-easy-fix and the answer I don’t like to hear goes something like this: “I stepped, [stood up, turned, tripped, jumped, landed, fell, slipped, knelt, squatted] and felt a sharp pain, [pop, snap, strange feeling] and then it was immediately painful and swollen the next morning.”  That usually indicates a more serious injury.  If you had something like that happen (sudden pain that occurred with a specific movement or incident) you should head to a doctor or physical therapist right away.  Clicks, pops, snaps and clunks that are painful are something to be concerned about.  As is any kind of “locking” or “giving out” sensation.

Getting back to the person who had the pain start slowly with no specific event (aka: insidious onset)– My next question is – Which part of your knee has the pain? The answer is usually one of these: along the outside (lateral) edge, above the kneecap, below the kneecap, behind the kneecap, along the inside (medial) edge, behind the knee.  For these scenarios, the knee pain is usually being caused by something (a muscle imbalance or strain) that affects the alignment of the knee.  It’s a difficult theory to accept at first but hopefully I can explain it well enough to get people going in the right direction toward fixing the problem.

In my next post, I’ll start with the most common type of knee pain – lateral knee pain, often referred to as IT band syndrome.   This is where the IT band passes over the lateral condyle of the femur, creating friction that eventually leads to pain.  It’s very, very common in runners.

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