Runner’s Knee: A Common and Recurring Issue

Brian L. Mahaffey, MD, MSPH, FAAFP
Mercy Sports Medicine

“Runner’s knee” is a lay term used to describe issues that are related to the patellofemoral joint; also known as the knee cap. Specifically, these diagnoses include patellofemoral pain syndrome, iliotibial band syndrome, patellar tendonitis and pes anserine tendinitis. These are not related to acute injuries and will improve with rest. Symptoms typically increase with activity with anterior (front) knee discomfort, problems with flexion/extension activity such as stairs, squatting and running inclines. People will typically have a tight feeling in their posterior knee and may have popping of their knee that is usually pain-free. Some patients also report stiffness when they first stand up; this is termed the “theatre sign.”

Many times, in seeing these issues, we at Mercy Sports Medicine hear patients are told to quit running, take pain medicine and concentrate on localized therapy. In reviewing the internet and therapy studies, the “gold standard” of therapy is to strengthen the quadriceps muscles and improve the flexibility of the hamstrings. Frankly, we have not found this helpful. Ultimately, it does not answer the question, “Why is this occurring?” By concentrating treatment to just around the knee, the underlying biomechanical issues are not resolved. Therefore, patients tend to have recurring issues.

So, “Why is this occurring?” Our bodies are similar to machines; if they are out of balance or inefficient, they tend to break down. The analogy that fits best is when you have a bad tire on your car. You have to fix the tire of course, but the car may be out of alignment, which led to the tire problem in the first place. It is the “Why?” When the repair shop realigns your car, it prevents recurring tires issues. You do not have to return to the repair shop often to realign your car; you expect it to maintain alignment.

A large majority of runners cannot maintain their movement patterns and symmetry with their whole bodies, leading to increased stress within the system, most commonly around the knee. By improving and maintaining a patient’s alignment and stability, overuse injuries such as runner’s knee resolve and continue to do well. We not only look at strength and flexibility, but how your neurological system influences your movement. With our approach, your breathing patterns also improve, leading to less fatigue. We see people resolve symptoms quickly, return to activity faster, improve their ability to maximizing your movement efficiency and have less chance of recurring issues.

Mercy Sports Medicine helps to remove recurring knee injuries from the equation for most runners by treating the whole person rather than just the site of pain. By not just “fixing the tire,” patients are able to return to running, are better runners, and enjoy it more. And that is what it’s all about, isn’t it!!

Dr. Mahaffey, MD, MSPH, FAAFP, is director of Mercy Sports Medicine and a team physician with the St. Louis Cardinals.

Mercy Clinic Sports Medicine offices are located at 15945 Clayton Road, Suite 210 (Phone: 636-893-1360) and 633 Emerson Road, Suite 20 (Phone: 314-325-3068).