Runner’s knee is a catchall term for numerous conditions that cause aching around the kneecap. As the name suggest, it is prevalent among runners but it can afflict other athletes as well.

Understanding runner’s knee
Dr. Sara Edwards, an orthopaedic surgeon at Northwestern Memorial Hospital in Chicago, said, “There seems to be a threshold for runner’s knee which is different for each person. Some people can run 3 miles/day without problems, but when bumped up to 5 miles/day experience pain.  Other people can do marathon after marathon without any issues.”

The cartilage beneath your kneecap absorbs the shocks received when running. Damage to this cartilage is called chondromalacia patella, or patellofemoral pain syndrome, according to the Mayo Clinic. More commonly, this damage is known as runner’s knee and is the most frequent overuse injury for runners.

Dr. Michael Terry, also an orthopaedic surgeon at Northwestern Memorial, stated, “Runners knee prevention is pretty challenging in most patients. Common tactics to avoid it employ quadriceps strengthening exercises, rest, ice, NSAIDs [Nonsteroidal anti-inflammatory drugs], and shoe/footwear modification.” To better understand why these tactics help prevent runner’s knee, it’s important to understand the ailment’s underlying causes.

Causes
It occurs when a runner has a poorly aligned kneecap, causing the kneecap to move incorrectly over a groove in the thighbone. This irritates the femoral groove and damages the cartilage beneath the kneecap, according to Nemours.Trauma to the knee, weak or tight leg muscles, over training and flat feet can also cause runner’s knee.

Risks for women
Women are more prone to develop runner’s knee because women generally have wider pelvises, increasing the angle at which the bones in the knee joint connect.

Symptoms
Anterior knee pain manifests itself as an aching, dull pain behind, below or on the sides of the kneecap, according to the U.S. National Library of Medicine. This symptom can increase when pressure is applied to the knee — including knee bends, walking down stairs or standing after extensive sitting.

Prevention
As the old adage goes, the best defense is a good offense. As a runner, you should be vigilant about runner’s knee and make a concerted effort to ensure that it doesn’t happen to you. The American Academy of Orthopaedic Surgeons (AAOS) reports that by staying in shape you reduce your risk of developing this condition. If you are overweight, you may place too much unneeded stress on your knees.

You should increase training intensity gradually to help with prevention. Dr. Edwards said, “To avoid runner’s knee, you want to slowly increase your running distance and intensity when beginning training, particularly if you have been pretty sedentary.”

You need to use proper running shoes with adequate support. Also, do not use your running shoes for other activities, as this will wear them out faster. After they can no longer serve as your running shoes, you can use your shoes for casual days. Inappropriate footwear is a leading cause of runner’s knee. The Cleveland Clinic recommends replacing your running shoes every 400-600 miles.

When running, vary your running surfaces. Repetitive stress often causes runner’s knee. If your body absorbs the shocks of running from different surfaces, your knee will receive the impact differently.

You need to run with proper form. Poor posture and uneven gait might cause knee troubles. Poor posture may be do to underdeveloped core muscles. Dr. Edwards said, “Strengthening of the ‘core muscles’ of the body (abdominals, gluts) also helps to prevent anterior knee pain.”

Dr. Edwards also suggests muscle strengthening and stretching: “Quadricep strengthening with stretching of the IT band are good preventative treatments for this problem.”

Treatment
AAOS recommends treating runner’s knee with the RICE formula: rest, ice, compression and elevation. This entails not putting pressure or weight on your injured knee, applying ice to the knee for brief periods several times throughout the day, wearing an elastic bandage or knee sleeve and keeping your knee elevated higher than your heart.

Dr. Terry said, “Once it [runner's knee] is present, anti-inflammatory medicines and quad exercises are our primary treatment.” The AAOS also suggests taking nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen.

In more serious cases reconditioning may be necessary. But for the most severe cases of runner’s knee, surgical procedures — such as and realignment—are used.