Runner's Knee Part 4: Treatment, Rehabilitation, & Return To Running

After three exhilarating weeks of discussing Runner’s Knee, we have covered the anatomy, mechanism of injury, hip and ankle mobility, training modifications when injured, and self-care options. This week, we culminate with what happens when self-care is not enough, when you need to seek help, and what that looks like.


When to seek care while dealing with patellofemoral pain is a common question we encounter.  In all honesty, as a runner, our natural tendency is to ‘wait & see’ and try to run the problem away. Furthermore, some will try and rest a week or two, putting training on hold, only to start running again and find the knee pain is still present.  

Not to be all high and mighty, but in my professional opinion, the earlier you seek care, the less likely you are to lose precious training time, and the quicker we can get you over Runner’s Knee.  To help simplify this, here are three rules to adhere to when debating care for your knee pain.

Knee pain is worsening with each run, earlier in the run, and lasting longer after each run causing your training to suffering.
Knee pain is not responding with consistent self-care and proper warm-up and cool-down routines.
Knee pain starts to be present during regular daily activities such as walking, taking the stairs, and rising from a chair. 


So, you have decided to seek help with Runner’s Knee.  

Step one: find a doctor that runs!

Now that step one is out of the way, let's talk about the basics of what actually happens and what you can expect from care in a sports medicine/chiropractic office.  

To get us started, let's look at the hardest question first...How long will it take?  That is a hard question to answer because every case is different. Each person presents with a different level of pain, unique exacerbations, varying training volume, intensity, and running age as well as racing expectations and outlook on their condition.  From all of that, nailing down an exact timeframe to peak performance is elusive. However, typical treatment plans range from 2 weeks to 2 months, again depending on goals and time the condition has been present.

Once this is understood, next is to understand that this is a team effort.  For the majority of clinics, you will only be actively receiving care for 1-2 hours per week.  What happens the other 166 hours of the week is up to you, and we discussed that in our last article regarding self-care.

When an athlete presents to a clinic like ours, treatment should be a 3-tiered approach.  

Soft Tissue:  As we have reviewed the anatomy, we know that there is significant muscle ‘issues’ involved in runner’s knee.  For this reason, this is where we start. How to decrease the tension and abnormal pull from muscles so that the patella tracks correctly and decreases joint wear is one part of the puzzle.  There are numerous ways to achieve this and in our clinic, we find Dry Needling, Active Release, IASTM - instrument-assisted soft tissue mobilization, and cupping therapies to provide the best, and quickest, results.  
Joint Mobility & Stability: After the soft tissue is addressed, we look at the structure.  As discussed in our second article, the mobility of the hip and ankle are vital to correcting and relieving runner’s knee pain.  Manipulation is designed to restore normal motion to a joint that is currently not moving properly. Over time, restored joint motion can improve running mechanics and decrease strain and stress placed on the surrounding muscles.  
Rehabilitation Exercise:  Lastly, once we have the muscles and joints under control, a building back up must occur in two ways.  One, we must create stability and control of the joint through muscle strength. Two, training volume must begin to ramp up, slowly and controlled, which we discussed in the third article of this series.  To further address part one, rehabilitation exercises need to be explained and directed.

Below is a basic 3 phase rehabilitation program aimed toward relieving patellofemoral pain, while helping to build back up and prevent future occurrences.

Phase 1:   During the first phase of care, our exercise prescription is aimed at pain relief and mobility improvement.  These exercises should be performed 3-5 times per week, preferably as part of your running warm up if we are able to continue training through care.  We start with 1 set of 10 reps for each exercise and 30 seconds for the wall sit, working up to 2 sets over the course of this phase of care which is typically 2-4 weeks.


Phase 2: The second phase of care focuses on returning to your full running volume while building strength and stability.  We expect to perform these exercises 3-5 times per week again, preferably before running but we will start with 1 set of 15 for each exercise and a 45-second hold for the wall sit.  Over the 2-4 weeks of this phase, we will work up to 2 sets of each exercise.


Phase 3: The third phase is aimed at strength and injury prevention.  At this time, we move to self-care as the patient is released from active care.  Our goal is to perform 2-3 sets of 10-15 reps for each exercise as a warm up before each and every run.  



Once we work thorough care and training is gradually ramping back up, or you have been consistent with home care, how do you know you are ready to return to full, unrestricted running?  To help determine if you can get back out there and get after it, we utilize our return to running assessment.  Our goal here is to complete each of the five exercises without pain.  In this assessment, each exercise must be completed for 60 seconds, with as many repititions as possible.  


Finally, we have covered more information than you could ever want to know about patellofemoral pain syndrome.  Hopefully this has been enough information to keep you out of our office, but...runner's have many other issues and injuries to face and Runner's Knee is but one of them.  Until next time...

Train Smart, Recover Well, Race Great!

-Dr. Reheisse

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.