Injury Focus Series 004

Runner's Knee

For this week’s running injuries blog on Runner’s Knee, we decided to do something a little different. We’re going to let Physical Therapist and Biomechanical Specialist Caitlin Alexander run the show!


Meet Caitlin

Caitlin is a D.P.T. who recently graduated from the University of Colorado and now works at BUILD Sports Performance Lab and Physical Therapy in Louisville, CO, USA. She’s passionate about human movement and believes that a patient’s evaluation in the PT setting should involve performing the movements that are causing their pain rather than avoiding painful movements altogether. This leads to more effective treatment!



What is Runner’s Knee?


Runners presenting with any kind of knee pain may claim to have “Runner’s Knee” however this is often an overgeneralization. Medial knee pain is often associated with the adductor muscles, while lateral knee pain is often IT band-related. The more correct term for Runner’s Knee would be “anterior (front) knee pain” or even “patellofemoral pain”. The clinical cause of anterior knee pain is actually inconclusive, but there is typically a biomechanics component.


Biomechanics issues potentially contributing to anterior knee pain include over-striding (which creates a braking force upon impact), hip torsion (causing the foot to point inward or outward), valgus of the knee (knock-knees), or having a stiff knee upon impact.


What are some misconceptions around Runner’s Knee?


First, the idea that heel-striking is the cause of running injuries such as Runner’s Knee or stress fractures in itself is a misconception. Regardless of what part of the foot makes contact with the ground first, the most important thing is that runners land with their foot underneath their body to reduce the braking ground reaction force associated with contacting the ground in front of your body, i.e. over-striding (see the runner in our graphic for a view of "over-striding").

Second, the idea that runners suffering from anterior knee pain must “strengthen the quads” is a misconception. In terms of biomechanics, the knee is done what it’s told by other areas up and down the kinetic chain, namely the hips and the feet/ankles. The hip in particular acts a bit like a steering wheel for the knee, so if the hip muscles are weak on one or both sides, then it effectively drives the knee into torque, which can lead to pain over time. Patients often think that their knees must be the problem if they suffer from knee pain, but really what needs to be assessed is strength and stability of the hip and foot.


What does Runner’s Knee rehab look like?


Unless a runner has pain even when walking, I don’t like to tell a runner not to run...they’ll just seek a second opinion and find someone else who will tell them they can! The first thing I implement is a strengthening program for the hips and feet. As a PT, I tell the patient that we’re not aiming for 0/10 on the pain scale while running, rather 1-2/10. Most importantly, we want to make sure pain is not increasing during running, and that the pain goes down to 0/10 24 hours after running. If those two boxes aren’t checked then we need to find alternatives to running before reintroducing it.


How can LEVER help?


With LEVER, we can decrease the trauma to the knee by reducing that impact force (ground reaction force). The specific use will depend on the athlete (elite vs. recreational) and time taken off due to this particular injury (days vs. months). For example, if a runner has taken lots of time off, I’ll put them through my return-to-run protocol to gradually reintroduce running. We have found that people can progress faster with BWS than with over-ground running because they can run faster and for longer without tripping over that 2/10 pain threshold.


Any runner who has taken a few months, weeks, or even days off from running knows that the first few runs feel downright strange. Coupling this with a return from injury, the reintroduction of running can feel foreign and scary. Using LEVER, we can safely reintegrate the neuromotor system to running, allowing the patient to maintain running-specific fitness and IQ before they are released to over-ground running. We can’t wait to use LEVER in our clinic!

Thanks for joining us, Caitlin!


FUN FACT! The LEVER team is currently hard at work to design an LV1 system that is compatible with BUILD’s HP Cosmos treadmill, a force plate-embedded treadmill capable of capturing biomechanics data and analysis! With a LEVER in their facility, Caitlin and the BUILD team can utilize BWS as part of their in-clinic rehab programs.


Nell Crosby, M.S.


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