Runner’s Knee: Patellofemoral Pain & Iliotibial Band Pain

Running is a fantastic way to stay fit and healthy, but it can also be tough on the body. With marathon season truly in full swing here in Australia, small niggles can quickly become injuries that limit our function, cause pain and prevent us from clocking those running miles.

If you experience sore knees from running or knee pain after running, you could have a condition known as Runner’s Knee.  Also known as Patellofemoral Pain Syndrome and/or Iliotibial Band Pain/Syndrome, Runner’s Knee is one of the most common injuries that runners of all abilities can experience. This nagging injury can become severe and hinder daily activities, making it important to address the cause as soon as possible. In this article, we discover the causes of Runner's Knee, how it develops, physiotherapy management, and preventative measures that minimises risk of injury.

So, what is Runner’s Knee?

Runner's knee is an umbrella term used to describe a variety of knee conditions that causes knee pain, often seen in the running population. Although more common in runners, this condition can be present with other activities including walking, hiking, jumping and cycling. Two of the most common conditions that typically are presented with runner’s knee include patellofemoral pain syndrome (PFPS) and Iliotibial Band Syndrome/Pain (ITBS).

Patellofemoral Pain Syndrome (PFPS) is a condition where pain occurs at the front, around the knee cap or behind the kneecap itself. The patellofemoral joint involves the posterior patella (kneecap) and the articulating groove of the femur bone (anterior). It is usually aggravated when performing weight-bearing activities, particularly those that involve the knee being in a flexed position such as running and squatting. It can also be painful when kneeling on the affected knee.

Iliotibial Band Pain Syndrome (ITBS) is a similar condition however this causes pain/tenderness on the outside (lateral) aspect of the knee. The iliotibial tract is a thick band of fascia that runs along the lateral aspect of the thigh. It descends from the deep connective tissues of the tensor fascia latae and gluteus maximus muscles and inserts into the lateral tibial plateau. It is usually aggravated when performing repeated flexion and extension activities of the knee such as running and cycling.

How does this occur?

Runner’s knee is usually a multifactorial issue and there are potentially numerous reasons as to why you may be experiencing pain. Investigative research has highlighted the biomechanical factors and strength weaknesses that cause pain. In clinic, we often see that pain is due to spikes in training/running load, poor running gait efficiency, strength deficits particularly for muscles at the hip and knee, muscle tightness and reduced dynamic stability and control, contributing to the development of PFPS and/or ITBS.

Runner’s Knee Treatment - back to running pain free!

Physiotherapy treatment for Runner’s Knee involves reducing the inflammation, pain and symptoms, using taping techniques, monitoring and managing your training/running loads. This involves an individualised rehabilitation plan tailored for you based on assessment findings. During the early stages we focus on managing and reducing your pain using manual therapy techniques, with longer-term rehabilitation focussed on building the strength and biomechanical qualities required to optimise performance and reduce pain. It is important to note that the exercises prescribed for PFPS are different to that for ITBS and it is imperative to ensure a clear diagnosis of the source of pain. Exercises that reduce PFPS may actually increase ITBS pain!

Can I prevent Runner’s Knee?

You can certainly reduce the risk of developing Runner’s Knee. Runners should increase milage gradually and avoid sudden spikes in running load. Ensuring you have cushioned, well supported running shoes is important to reduce impact forces at the knee, particularly if you are new to running.An injury prevention consultation with our physiotherapist to look at physical and biomechanical factors can provide valuable information about your risk of developing Runner’s Knee. We can then develop a tailored, individualised injury prevention plan with regular check-ins to minimise injury risk and optimise your training to achieve your goals.

Closing Thoughts

Hopefully this information has provided you more context as to what’s causing your knee pain and why it’s occurring. The painful condition of Runner’s Knee can be managed effectively with physiotherapy. The underlying cause of the condition, either PFPS and/or ITBS should be addressed to prevent recurrence.Prevention is always better than cure! If you are experiencing symptoms such as knee pain, or particularly if you are new to running or training for an event, a physiotherapy injury prevention consultation at Activate Health & Fitness in Brisbane’s CBD is recommended to address any factors that could predispose you to this injury. Happy running!

If you need to see a physiotherapist in the Brisbane CBD, our experts can help you. Don't put up with pain, book your appointment today.

By Stephen Valassakis BSc (Hons), MSc, APA