Runners Knee: Marathoners #1 Knee Injury. Here are the Details.

Spencer 20Richards 20Marathon
​Coming to you from sunny St. George where we’ve just enjoyed the 37th running of the nationally renowned marathon. This year’s race featured runners from all over the United States and nine foreign countries.  Not surprisingly, Utah was the most represented state with 63% of the total 7600 participants. I was surprised to read on the official race website that there were 14 runners who have completed over 30 St. George marathons in this year’s pack. Amazing! 

Race day started chilly (with temperatures almost hitting 30 degrees at the starting line), but the weather warmed to mid fifties as most of the runners crossed the line.  The men’s winner, Bryant Jensen, finished in new course record time – 2:15:57! Women’s winner, Rosy Lee, ran away from the women’s field as well, finishing 3 minutes ahead of the second place runner in 2:37:04.  Overall, I heard from runner after runner about how enjoyable this year’s race was. Spirits were high and smiles abounded in the finisher’s pen.

Intermountain Healthcare was one of the title sponsors again this year. Our colleagues in the Utah Southwest region were proud to provide medical care for the race. Big shout out to the great doctors, athletic trainers, and other staff who helped keep so many runners going.

Marathon training and racing can take a huge toll on one’s body.  As Sports Medicine physicians we frequently see injuries in patients who are training for a marathon. Runner’s World magazine compiled a list of six common marathon injuries. In this blog will look at Runners Knee, its symptoms, treatment and how you can prevent it.  We will follow with additional posts for the other five common injures in the coming weeks. 

#1 marathon running injury: Runner’s Knee.​ 

Runner’s knee, a condition also referred to as patellofemoral pain syndrome or PFPS, occurs in 15-40% of all runners training for marathons.  Pain is caused by irritation of the cartilage on the underside of the kneecap (patella). Common risk factors for developing PFPS include long runs, downhill runs, inward rotating or pointed knees, weak hips/glutes and excessive pronation.  

Symptoms: Pain is typically located in the front half of the knee. Pain is usually worsened going down stairs, squatting, bending or kneeling and even after sitting for extended periods of time. Occasionally, swelling, popping or grinding, and even instability can be felt.

Treatment: rest can be helpful, but studies have shown this doesn’t have to mean lying around for weeks waiting for the pain to subside. Uphill running, short runs, elliptical or cycling workouts, and strength training can be done while the knee recovers. Ice after workouts is important (15-20 minutes immediately after exercise). Anti-inflammatories can be helpful in the short-term, but rather than taking ibuprofen or aleve just when the pain seems its worst, studies have suggested that consistent use (daily) for 2-3 weeks can be more helpful in the long-term. Although some studies refute the benefit, some runners swear by using athletic tape (or K-T tape) to help patellar alignment and tracking as well.

Prevention: once you have PFPS, you’re behind the eight-ball so to speak, but it’s never too late to strengthen your muscles to prevent excessive wear on the cartilage behind the patella. The most important muscle groups to strengthen are the glutes, quad, and adductors (groin or inner thigh muscles). Avoid deep squats or lunges which can irritate the patella.  Exercise bands are effective in strengthening these muscle groups and can be inexpensively and conveniently used anywhere. 

In the next blog post we will look at Achilles Tendonitis, a condition that derailed my own training for this year’s St. Marathon. If you can’t wait,  follow us on facebook at