Jill Murphy, DPT, LAT, CSCS
Nothing can stop a runner in his or her training like the pain and swelling involved with anterior knee pain, otherwise known as "runner's knee." This pain can come on slowly over time, or rear its ugly head after a hilly or stairs work-out, or even after a particularly challenging hike with steep hills and/or stairs.
With only one symptom of dull, achy pain at the front of the knee, this injury can seem indistinct and nebulous, but one of the cardinal signs of pain in this area is that you have nearly full range of motion in your knee (full ability to bend and straighten) with the pain present with only a fully extended or fully bent knee. The actual source of the pain is likely to be patellofemoral syndrome in younger people, which is knee pain related to poor tracking of the femur and patella at the knee. In the older patient or in a patient with a history of previous patella injuries, chondromalacia, an early degenerative process affecting the cartilage that lines the knee cap (patella) or the area of the femur that articulates with the patella is likely to be the cause of the pain. Typical symptoms for chondromalacia other than pain with jogging can be pain with prolonged sitting, squatting, kneeling, driving, stairs, sprinting, rowing, kicking, jumping, or any other activity requiring a knee bent close to 90 degrees.
What can be done for this type of knee pain? Ice, rest, and avoidance of activities where the knee is bent to 90 degrees is optimal. Some physical therapy that includes exercises that strengthen the quadriceps, gluteus medius, and gluteus maximus are also very helpful, as well as some modalities that can drive anti-inflammatory medicine into your knee will help address the swelling that is contributing to your pain. Finally, careful instruction in correct technique for the functional use of your knee that includes squatting, lunging, and single leg squats or touch-downs, will help you return to your previous level of activity.
For some patients, participating in a formal rehabilitation program is not enough, and they may require an MRI to see if there is any damaged cartilage that may be catching under the knee cap. If so, arthroscopic knee surgery to trim away the damaged cartilage is very successful in eliminating the source of the pain. While it is surgery, it is a fairly minor one that patients can quickly recover from with a few sessions of post-operative physical therapy to get you back on track. While chondromalacia is a form of early knee arthritis, if patients continue to avoid activities that repetitively stress this area with large amounts of force (deep squatting, kicking, prolonged sitting and driving, stair running, sprinting, rowing, etc), they should be able to continue in a running program and most other types of exercise problem-free for many years to come.