Runner’s knee, or patellofemoral pain syndrome, is one of the most common running injuries
Two large scale scientific studies have confirmed this.
A 2003 study of over 800 runners training for a road race in Canada found that runner’s knee alone accounted for almost one third of all of the injuries sustained by the sample group over the study’s 13 week duration.
Another study published the year before evaluated over 2,000 injured runners that visited a sports medicine clinic. Again, runner’s knee was by far the most common injury accounting for twice as many injuries as the next most common problem (IT band syndrome), and made up 17% of all injuries.
Why is Runner’s Knee so Common
The tremendous forces transmitted through the knee during running might be one reason why it’s so commonly injured.
The knee is the focal point for the quadriceps and hamstring muscles, which produce a large proportion of the energy you need to maintain your speed when you run.
In healthy runners, the knee is able to handle these huge forces being transmitted through it with each stride thanks to our innate biomechanics.
During normal running and walking the kneecap, or patella, slides up and down a groove in the end of the femur when you straighten and bend your knee.
However, for runners who have weak hips or quadriceps, the patella isn’t able to track properly in this groove.
Thus, the patella rubs up against the edges of this groove in the femur and causes the pain you feel with runner’s knee. Hence the technical term for the injury, “patellofemoral pain syndrome.”
Currently, there are a few biomechanical theories as to what causes the kneecap to rub against the groove in the femur.
The traditional explanation has been that abnormal or imbalanced tension from the quadriceps muscle alters the tracking of the kneecap.
This hypothesis is supported by evidence from a seven year study of patients with runner’s knee, which found that restoration of quadriceps strength is associated with a better likelihood of recovery in long standing cases of patellofemoral pain.
Other research found abnormal activation patterns in the quadriceps on the injured side, providing additional support for this theory.
More recently, research has uncovered another mechanism that contributes to knee injuries in runners: hip mechanics.
It turns out that, while it appears that the kneecap “tracks” towards the outside of your leg during squatting and running motions, it’s actually the femur rotating underneath the kneecap.
This explains why many runners (particularly women) with patellofemoral pain syndrome have weak hip abductors and external rotators.
This seems to contribute to altered biomechanics when they run. Because of their muscular weaknesses, their knee “collapses” towards the center of their body when they run.
The good news is that new research has uncovered ways you can treat runner’s knee and even prevent it from occurring.
NuNee: A 90% Effective Treatment for Runner’s Knee
It’s not often we see independent clinical research on an injury-prevention device that provides both short-term and long-term relief from an injury.
But, that’s exactly what we’ve got thanks to the Nazareth College School of Physical Therapy in Rochester, NY.
In 2022, the researchers performed two studies. The first was to determine the immediate effects of using NuNee to relieve runner’s knee within the first 2 weeks.
The second round of research was to determine the effect of using NuNee for 6 weeks to determine if it could help with runner’s knee long-term.
Immediate effects
Participants were screened for anterior knee pain using a standardized musculoskeletal exam to rule out causes of knee pain that would exclude participation. They were then asked to identify their current level of pain on a 0-10 numerical rating scale.
Subjects completed a single functional test including stair ambulation, squat or running, depending on what was most provocative.
They completed testing without any type of brace then with the NuNee device, and a pain rating was recorded during each test scenario to identify immediate response.
When engaging in provocative activity, 89% reported decreased pain immediately after donning the NuNee brace.
Results show a mean score of 3.38 on the numerical rating scale with provocative activity without the brace, and 1.62 with the brace, resulting in significant decreases in reported pain. Five participants also reported improvements in their pain at rest when wearing the brace.
6 week follow-up
After six weeks, participants demonstrated statistically and clinically significant changes in Kujala and numerical rating scale scores. The Kujala test is a 13-item screening instrument designed to assess patellofemoral pain in adolescents and young adults.
During functional testing at follow up, 100% of participants reported pain scores of 0/10 while using the brace.
These findings suggest that the NuNee brace can reduce immediate and long-term pain and improve function when worn during physical activity in individuals with anterior knee pain.
If you are suffering from runner’s knee and want to give NuNee a try, head to nuneeshop.com. They offer a 100% moneyback guarantee if it doesn’t work for you, so there’s no risk to give a it a try.
Long-Term Prevention of Runner’s Knee
It’s always important to remember that with running injuries, you need to treat the source of the pain and not just the pain.
The NuNee device is fairly unique in the sports-injury world in that it’s one of the few things to provide immediate relief for an injury so that you can continue to train.
But, that doesn’t mean the underlying issues are fixed.
It’s imperative that you also address the underlying quad and/or hip tightness and weakness or you may find yourself stuck with a different running injury you can’t run through.
So, what is the best treatment method?
First up is quad strength. Two main exercises are commonly used in rehab programs to target quad strength (see video below for demonstrations).
- Straight leg lift
- Mini squat
Second is hip strength, the most effective exercises for retraining your hip abductors and external rotators are as follows.
- Glute bridge, ideally with a resistance band around your knees
- Monster walk, which also requires a resistance band
Next, to improve hip coordination, there is one exercise you can do. And one visual cue to use while you run.
- Single leg balance on a wobble board or BOSU ball can help translate strength gains into better control of the leg when you run. You can start with one minute of balance. Then build up to two sets of two minutes over time.
Finally, to really translate your gains into running, you need to work on changing your knee mechanics while you run.
- The best drill for this is to put two short strips of athletic tape on your knees. Next focus on keeping the “face” of the tape pointing forward when you run. The tape isn’t doing anything special. It’s just providing you with a visual cue to keep your knees pointed forward.
- When your foot hits the ground, check to see whether your knee buckles inward. If so, you’re still putting extra stress on your knee. Keep those knees pointed straight ahead.
And as a note, some research has connected tight quadriceps and calves to the development of runner’s knee.
- So it’s essential that you also stretch your calves and quadriceps for two sets of 30 seconds each. Do this several times per day.
Here is a video that demonstrates these exercises and stretches
Though these exercises are designed for recovering from runner’s knee, you can use a pared down version with fewer sets (if you’re pressed for time) as a way to prevent runner’s knee.
Keeping your hip and quad strength up, as well as stretching and improving your knee mechanics when you run, are all good ways to defend yourself against the number one running injury.
