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!