When I first started getting into running again a while back, I was a bit too enthusiastic and ran more distance than my body was prepared for. After my first race I ended up suffering from something that just about every runner has had to deal with, knee pain.
After the fact, I realized that the pain was the result of poor flexibility and bad running form which was facilitated by shoes that allowed me to heel strike.
I don’t have to worry about that kind of pain now because when I run I do so barefoot or in my Vibram Five Fingers (it’s hard to run in poor form without cushioned shoes, the pain will quickly force you run properly). But, that transition didn’t happen overnight and the process of rehabilitating my knees was a slow and deliberate process.
Today, I am happy to report that I run much farther distances than I was doing back then, and am doing it without any pain in my knees. So what did I do to heal my knees?
The first thing I did was schedule an appointment with a sports orthopedist. These are doctors that are specialized in treating injuries from activities like running, and are more likely to make an accurate diagnosis. An x-ray will also be useful for determining if there is any damage to the patella or the surrounding cartilage.
There are many different kinds of injuries that can involve the knee, but for me it was the very common patellofemoral pain syndrome. It is essentially a non-specific injury, often caused by poor knee tracking, and which is indicated by pain and inflammation of the patellar cartilage, and the front of the knee cap. Next, it was imperative that I stopped running until the cause of injury was determined and physical therapy was initiated to resolve it.
Through conversations with my training coach and my physical therapist, we surmised that my pain was the result of a combination of factors: excessively harsh heel striking, poor overall leg flexibility, and a far too aggressive training program. The therapist instructed me in several exercises and stretches that I needed to perform on a regular basis in order to get my legs into shape.
As it turns out, when the primary muscles of the leg (quads and hamstrings) are imbalanced they can have a tendency to pull the knee cap out of alignment within the femoral groove (the area the knee slides along when your legs bend). Poor leg flexibility exacerbates this problem because all of the main tendons of the leg connect at the knee joint.
Of course, my therapeutic exercise regimen included copious amounts of leg stretches, but it also incorporated an emphasis on proper squatting technique.
The way a person performs a squat can say a lot about the strength of their legs and the balance between the muscles of which they are composed. Practicing and perfecting the squat movement is essential for preventing injuries from every day activities, and maintaining the proper relationship between the leg muscles.
I was initially worried about doing that kind of exercise, but I found that if I went slow and concentrated on keeping the proper form, my knees were unexpectedly pain free. In fact, my knees felt better after the therapy sessions. So, reincorporating movement is an important part of the recovery process, but it is paramount that you do so within reason.
Other tips for recovery:
- Take glucosamine-chondroitin supplements. The jury is still out on these, but they may help. They contain the molecular building blocks for joint tissue and cartilage.
- Avoid sitting for long periods. The sitting position stretches the tendons over the patella, and increases pressure against the irritated cartilage without releasing it. This is usually referred to as the “movie sign” since sitting in a movie for several hours can leave you with hurting knees. I experienced this myself, in the theater, and on an airplane, and bus ride. It was a rough holiday.
- Ice the problem area several times a day, especially after workouts.
- Stop taking NSAIDs (“non-steroidal anti-inflammatory drugs” like ibuprofen) since they inhibit the healing process, and are known to reduce blood flow to cartilage. Pain-killers also prevent you from utilizing the “bio-feedback” from an injury. Pain is one of the ways that your body tells you that you’re doing something dangerous or injurious.
- Read the book Heal Your Knees by Robert Klapper, M.D. and Lynda Huey. It contained some great tips on self-diagnosing and recommendations for treatment.
In the end, once I started doing some light running (barefoot or with Vibram Five Fingers) my knees finally felt 100% again. Before that, the other stuff I had been doing had alleviated most of the pain, but there was still some minor nagging aches every now and then. It seems to me that there is something innately therapeutic about running barefoot.
With barefoot or minimalist running, your body gets a chance to move about and feel the ground like it was designed to do, and in turn it is able to tell you right away when you are doing something that will cause injury.
Of course, it is still possible to ignore those signals. The phrase “no pain, no gain” and the general attitude of runners to just suck it up and run through the discomfort probably leads to many unnecessary injuries. If we pay attention to our body, it will rarely lead us astray!
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20 Responses to How I Cured My Runner’s Knee Pain
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great article! it’s wonderful to hear people share personal experiences about diagnosis and treatment (or even better, cures!) of mysterious “syndromes”. so many physicians do have have first hand experience with this condition, which makes it difficult to empathize the severity of the pain. i am a victim to overuse and overload, resulting in what appears to be a NASTY case of bilateral patellofemoral pain syndrome and/or chondromalacia (depending on which MD you talk to). how long did it take for your case of chronic anterior knee pain to settle down?
I want to say it was about 2 weeks before the most serious pain subsided. After that, it was primarily just a nagging pain that would flare up during work, at movies or while traveling. About a month after the injury I started really working out again and trying to run again. The nagging pain didn’t really go away completely till I started running in my new Vibram Five Fingers though. It was surprising to me, almost like a light switch.
I’m glad to hear you identified and eliminated the risk factors contributing to your knee pain. I wish mine only lasted two weeks, but now it is progressing to a chronic condition. I think I’m going to look into the book you recommended. I saw a sports physician, orthopedist, and two physical therapists, and I don’t think they worked together as a medical team to prescribe the correct treatment/recovery plan. I’ve suffered since April 2010
Sometimes it hurts to walk!!!
I would look into other contributing factors like a potential high inflammatory diet, or bio-mechanical issues like proper hip function and squatting. Learning how to squat properly can go a long way to strengthening and balancing the leg muscles (all which connect through the knee). http://journal.crossfit.com/2009/08/the-knees-part-1.tpl
Thanks, David. My diet is clean, mostly Paleo with occasional dairy, whole grains, and legumes. Very seldom use of sugars, and I megadose the fish oils, bromelain, and other joint supplements like glucosamine, chondroitin, MSM, SAMe, Vitamin C, etc. etc.
Hip function was terrible.. and I was a wicked bad heel striker in running. So I’m working to correct the tissue imbalances that have warped my pelvis and lower body’s biomechanics.
I guess it’s a case by case situation, but I’m going on 12 weeks of physical therapy and no significant improvement. About 10% of PFS sufferers never get better… I don’t want to be part of a statistic! I’m wayyy too young for this!
Thanks for the CF link… I purchased a membership!
I’ve also been suffering from Patella femural syndrome. For me, the symptoms started in Feb. and I’m still in pain. I’ve been in physical therapy for waay too long. Had x-rays done. Now my physical therapist is ready to send me back to the orthopedic, who made the original diagnosis. Minella, I understand your pain. Wish both of our nagging pain would go away. It really changed how positive I’ve been. I had this electric stimulation therapy done to me this past thurs. That seemed to work for a few days, but, then this past Monday, when I had same treatment done, I felt worse, go figure. I’m open to suggestions of how to deal with this pain, the squats for me seemed to make my situation worse
@Shosh – I highly recommend accessing that CrossFit Journal link I referred to Minella above. Kelly Starret is a well known physical therapist, and has some great info on knee rehabilitation. If those squats are helping, it could be possible you have some lumbar or hip issues – transferring some bad loading to the knees.
Well that is a quite comprehensive overview of your recovery chart. Its nice to educate people with knee injuries about all this since rehab is the more important part of a successful treatment. Without that even the most expensive treatments are useless.
.-= Orthopedic Doctor´s last blog ..Broken Knee Injuries Symptoms- Diagnosis- and Treatment =-.
Similar story here; painful knee since April this year, did not respond to reduced mileage, strengthening exercises, etc. Two orthopedic surgeons had 100% contrasting advice: surgery and anything but surgery… In the end I switched to Vibram running exclusively & applied $8 capcaisin from walgreen’s three times per day. Knee pain all but gone, running up to 40 miles per week again… Oh and some fairly regular foam rolling before and after running, plus proper warming up by walking 1/4 mile+ at start of all runs.
That’s a fantastic recovery Joe, thanks for sharing your story!
Regarding the heel strike vs forefoot strike discussion, here’s a study from Harvard that supports the mid or forefoot strike:
http://www.barefootrunning.fas.harvard.edu/
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A great article – thanks for sharing your experience. It is good to hear a happy ending to a runner’s injury story. I have been reading a lot lately about barefoot running and I intend to try it. There are so many benefits. I am going to start by using a minimalist shoe, like Nike’s Run Free or New Balance Minimus. If that works out, I want to move to the Vibrams.
I also had problems with my knees running, but fortunately didn’t develop into anything serious. I was doing Feldenkrais lessons at the time for my back and they really helped me with my knee problem too.
Thanks for the article! I have a question if you wouldn’t mind sharing your experience.
I developed runner’s knee so did them same MRI, got diagnosed stretching and weight training. I still do it on a regular basis, very effective. But on long runs it would still shut me down, and forget about street running (soft ground only; trails, etc).
Then I picked up Vibram 5′s. Everyone told me I would have calf tightness. Actually, not one feeling of discomfort there, not at all. Instead, to my surprise, it seems I flared up the runners knee almost immediately!
Do you think I just need more time in the 5′s, with the body adjusting to the proper forward lean running and forefoot striking? Or do you think my knees are too weak for no cushioning?
tks in advance!!
The lack of cushioning shouldn’t be an issue if you are running with proper technique. The knees function with the rest of the muscles and tendons in your legs/feet to act as natural shock absorbers.
In my experience, this system breaks down when people run in thick shoes or heel strike. Make sure you aren’t landing hard on your heels.
thanks, David. I think that I might still be landing on my heels, actually. I need to slow down a bit….not try to hit my “shoe pace” right out of the gate. Thanks for the further confidence in using the 5′s!
Proper ankle and hip biomechanics are the most important in knee pain, any of those not functioning correctly and knee pain begins.