Runner’s knee

Runner’s knee


Pain at the front of the knee is an extremely common problem for runners, whether you’re a seasoned marathon veteran or a 2km novice. You are not alone!

Anterior knee pain (pain at the front of the knee) can affect anyone. It is, however, more common in runners, and people who play sports that involve running. I wish I could tell you that you need to do ‘this stretch’, lift ‘those weights’ and use ‘that’ foam roller, but whilst these may be valid, they simply won’t address the root-cause of the issue … particularly if they have been prescribed without any assessment. In fact, they could make things worse!


There is a multitude of factors that can culminate in the development of anterior knee pain. Often, it is not realised just how complex this injury can be. Attempting to explain all of these would have you stood or sat where you are for a number of hours, so I am going to stick to the basics for the time-being, and hope that you can relate some of what I say, to your injury.


What (you’re thinking)?! Well, it’s true – maths may have the answer. There is an angle in the body called The ‘Q Angle’, and this has been proved to play a huge role in the development of this condition. A picture is worth a thousand words, so let me show you. The figures shown are only rough guides, so don’t take them as gospel, but it really is as simple as that; the angle shown changes everything! We all come in different shapes and sizes, and these subtle variances could be working against you and your running. But that doesn’t mean you have to stop exercising! It’s if this angle is increased that you need to start considering it as a cause. It will change the line of force that your quads pull through your knee, and therefore the ‘tracking’ of your patella (knee cap) over your knee joint – more to come on this later, but for now, read on.


Figure 1 Illustration of the Q Angle


The shape of the bones in your knee could also play a huge part in how your patella sits over your knee and, therefore, how your knee functions. There are ways that your Osteopath can screen for these anatomical variations. However, the single best way to view this is via the affectionately termed ‘skyline’ view X-ray. The end of your femur (thigh bone) can also vary in its shape, particularly the part over which the patella sits. Having said all of this, provided you don’t feel as though your patella is unstable and shifting side-to-side on your knee, this isn’t necessarily the answer … the plot thickens!




Figure 2 Illustration of how the patella can sit over your knee


The last potential culprit is your soft tissues (muscles and ligaments). The patella is what is known as a ‘sesamoid’ bone; this means that it is engulfed by tendinous tissue, in this case, the quadriceps tendon. If there is imbalance in the quadriceps muscles, patella ‘mal-tracking’ may well be adding to your woes. To give you an idea of the forces sustained by your knee, studies have shown that when you land from a jump, a force of up to 6000 N (newtons) is placed through your knee joint. Imagine what it must be when you are sprinting! There are two main structures to be concerned with here. Firstly, the balance of strength and tension in your iliotibial band (ITB), vastus lateralis and vastus medialis (outer and inner quad muscles respectively) needs to be right. After all, they are holding the patella is place! Secondly, a ligament called the medial patellofemoral ligament (MPFL). This will restrict too much lateral (away from the midline of the body) movement of your patella and help keep it on the straight and narrow.


Remember, these are the basics – believe it or not! The single thickest bit of cartilage in your body is on the back of your patella. To avoid damaging it as much as possible, get your knee checked out if you are having problems! Whether you are running on the road around Moorgate, or at The City Point Club, Perfect Balance are here to help.

Author: Diego Bresciani

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