Over the last two weeks, we have discussed the ins and outs of what Patellofemoral Pain Syndrome is, the anatomy involved, how adjacent joints (hip and ankle) can lead to maltracking issues, and why runner’s are specifically susceptible to this common overuse injury. You can read Part 1 & Part 2 here.
Now it’s time to talk self-treatment and training modification. Our goal is to maintain training (load) if possible when you find Runner’s Knee settling in, but more times than not, rest and self-care is needed while also modifying our training volume and intensity until symptoms recede.
TRAINING MODIFICATION FOR RUNNER'S KNEE
Let's get the big one out of the way first! One of the reasons many runners try to avoid visits to a doctors office about one pain or another is the fear that the physician will tell them to stop running. Depending on the injury, how long it has been going on, current severity, and many other factors, some runner’s are able to continue training during treatment and rehab, albeit modified.
Without getting too technical, we have to first understand the concept of 'load' and how it changes when we are injured. As runners, we have a specific language so I am going to explain it in those terms. When our training is on and we are injury free and fit, long runs, speed work, tempo runs, and intervals go well and help us improve. The amount of load on the knee (and other joints) is well handled and time is ample to recover. Now, let's say you decide to sign up for a race that is in 6 weeks and your training base is less than optimal. In hopes of having a good race, you ramp up quickly, performing hard days back to back, pushing it to your goal race pace over a good portion of your long run, etc., and now...BOOM, knee pain! What has happened here is that you crossed over the load threshold of what your body will allow and recovery from.
For an interesting read, look into Scott Dyes work. This is what is commonly referred to the ‘envelope of function’ in the coaching and physician world.
Jumping back in...now that we are injured, our load threshold is lower. This is why a 5-mile run is painful halfway through when just 2 weeks ago, you were cruising through 10 miles with a few pickups. If you continue down this path, patellofemoral pain can become so severe that just getting out of bed and navigating stairs are difficult. When we encounter a runner in this position, we have to have a sit-down and talk training plan, race expectations, and our long-term goals.
While it is never our goal to shut a runner down in the middle of a training cycle, the long-term health and ability of the athlete is top of mind. Because of this, when discussing training, we tend to cover three things.
Can we gradually ramp up training while continuing to respond to treatment?
When we begin treatment, we have to start with a baseline. That may be 2 miles, 5 miles, or No miles before the pain sets in. That is our starting spot. As we follow-through with the suggested treatment plan, this load threshold must also go up. Rarely does pain go from 100 to 0, meaning, the pain goes from beginning at mile 2, then mile 4, then we find ourselves back up to 8-10 miles with no pain. This is the progress we look for.
Initial volume should decrease by 50% for the first 2 weeks.
If you are coming to us for knee pain, make a conscious effort to dial it back for a few weeks. This allows you to keep training, but also a little more rest than normal while we get through the first few treatment session.
Intensity, or pain provoking runs, need to take a full break until volume can increase without pain.
With runner’s knee, we find that the harder, hillier efforts cause the most problems. While we want to maintain load on the knee while we treat, easy runs are the plan for the first few weeks. Looking at what we just talked about with gradually ramping up, we need to make sure you can handle a good distance without pain before we start pounding out the speed-work and hill repeats. And this goes for downhill too!
SELF TREATMENT OPTIONS FOR RUNNER'S KNEE
Now that we have discussed training modification, what can you start doing at home to help with Runner’s Knee? Honestly, you should be doing all of this already, but pain is a much better reminder to break out the foam roller than a good run. Your relationship with your foam roller needs to be strong. Your diet needs to be on point. Your bedtime needs to be early. Lastly, you need to realize that weight training is your friend.
Let's discuss a few of the easiest and most common self-treatment options.
I don’t need to further detail my love for foam rolling over stretch or the benefits that regular foam rolling can provide for a runner. As we address runner’s knee, rolling needs to be frequent, short bursts throughout the day. Meaning, roll the quadriceps, hamstrings, and posterior hip muscles 3-5 times per day. Again, these are short 2-3 minute sessions. 10-15 rolls up and down over each area. Check the video!
Hip Mobility Drills:
As runner’s, our knee functions is highly influenced and controlled by what is happening at the hip. If your hip range of motion is limited, this will eventually show up at the knee. Check the video!
Ankle Mobility Exercises:
As a practitioner, I’m typically a ‘ground-up’ person when it comes to runners. While the hip controls the show, if the ankle does not move properly, it can not react properly or efficiently when the foot hits the ground causing problems up the chain. Studies show that just a few degrees difference between ankles is a good indicator of future injury. Work on your ankle mobility - Check the video!
This is a bit controversial. As you will hear me say in the demonstration below, the effect of taping is hard to prove. Don’t get me wrong, I love taping, in the short-term. It is by no means a long term fix for any injury! With that, you can also find 500 runners at the upcoming Big Cottonwood Marathon or the St. George Marathon that have their knees, shins, hips, and ankles taped that will absolutely swear by it. With all of that, I just don’t have solid evidence that proves any of that...but placebo is a powerful tool and I do appreciate taping as a means to help someone recovery and cue good movement patterns. If anything, the tape is a visible reminder to roll, stretch, and rest more. Check the video!
BMI has to be briefly discussed her because whatever weight we are carrying around affects our knees! Remember from the part of this series we mentioned that during running, the knee takes on 5-6 x’s your body weight during each step. While many people us running for weight loss, and other avoid it due to weight, the fact is, those with knee pain will benefit from weight loss if they are in the higher BMI category. I am not a dietician, we do not push weight-loss in our office, and I can’t tell you how many ‘Clydesdales’ category runners that can kick my tail in a race. Health is more than just pounds, but Runner’s Knee can be helped by a better BMI.
Lastly, psychosocial factors. Runner’s are among the worst when it comes to injuries and the doom and gloom that comes with it. Some are severe enough that I have referred out to a professional for guidance. This is not something to be ashamed of and can actually help your recovery and performance. We now understand pain a bit better than we did 20 years ago, we still have a long way to go, but we know one thing to be true, if you do not think you will get better, you won’t. You have to buy into the plan, think positive, take the little wins, and know that this will not last forever. Any injury will last longer than we want it to, but you have to realize that by pure running statistics, you will get hurt at some time if you are training consistently, but it will also pass.
Hopefully, this article cleared up a few things regarding your training and the ability to continue through treatment as well as a few ways to care for Runner’s Knee yourself. Ideally, you can manage this yourself, learn from it, and prevent it from coming back again. As runner’s, we are prone to injury, that is just the way it is. But, we want to make sure you have the necessary knowledge and tools to help yourself before you give up, stop running, and then drag yourself into a sports physician office.
LET'S REVIEW TODAYS INFORMATION
When faced with Runner's Knee, training modifications are a must. We typically cut the volume by 50% and refrain from intense workouts (intervals, hills, tempo) for the first 2 weeks.
Self-care is a must. It not only helps speed your recovery over your treatment plan but it can help prevent future injury.
Self-care can be as simple as foam rolling a few times per day to running specific mobility, stability, and strength exercises.
Stay tuned for part 4 where we will discuss when to seek treatment and how we treat Runner’s Knee in our office, as well as a few examples of our suggested rehabilitation exercises.
Train smart, recovery well, race great!
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.