How many of us have painful knees that creak, crunch and grind when we wake up in morning, have been sitting for prolonged periods or when we’re walking down hills or stairs? I would say a fairly high percentage of us do.

So what causes these noises and sensations? One of the most common causes, is a problem called ‘Runner’s Knee’. Runner’s knee is a wearing away of the cartilage underneath or around the kneecap (patella), resulting in inflammation and pain. This wearing away can come in several forms, To begin with, a softening of the cartilage occurs, progressively followed by cracking or even tearing.

So what causes this to happen? Well, there are several reasons. One of the major causes is overpronation of the feet, as a result of muscle weaknesses in the thigh and hip (quadriceps, hamstrings & external hip rotators). Overpronation is when the feet rotate too far inward, squashing the arches during impact. This causes the patella to twist or be pulled inwards. In order to counter balance this, the quadriceps (front high muscles) will naturally attempt to pull the patella outwards. The consequence of this tug-of-war, is that it forces the patella to rub against the thighbone (femur), causing inflammation and pain.

Another cause is a weakness in the quadriceps muscles alone. Because the quads play a role in ensuring proper tracking of the patella, any weakness, particularly in the inside head of the quadriceps, can have an adverse effect on the smooth running of the patella and rubbing can occur.

Weak quadriceps combined with tight hamstrings (rear thigh muscles) and a tight ilio-tibial band (ITB, lateral muscle from hip to lower leg) can have lasting, damaging effects as the joint itself is pulled so tightly together that normal range of movement (ROM), cannot occur without hindrance, ie the joint structures grinding together.

There are also external causes of runner’s knee, such as excessive hill work, extensive sprint training, overtraining, running on sloped surfaces and incorrect or over worn footwear that doesn’t offer adequate support.

So how can we treat this problem, or perhaps more importantly, how can we prevent it?

For acute cases of runner’s knee, it is appropriate to employ R.I.C.E. (Rest, Ice. Compression and Elevation), in order to bring down the swelling and get some degree of ROM back into the joint. Then, before strengthening can occur to address the muscle imbalances, full ROM in each joint and muscle concerned, must be achieved.

With muscle imbalances, one set of muscles is weaker, therefore it has to work harder or contract harder, hence shorten and tighten, more than it’s opposing set of muscles. Therefore, a lengthening or stretching of such overworked muscles must occur, in order to begin the muscle rebalancing process.

Active Isolated Stretching (AIS) is a safe and extremely effective method of facilitating such muscle rebalancing, as well as preventing the onset of runner’s knee all together. Using AIS, it is important to stretch the gluteals, quadriceps, hamstrings and ITB, as these are the major muscles involved with the injury. Stretching these muscles and muscle groups, can help to decompress the knee joint, thus preventing any further rubbing of the patella on the femur.

Whilst maintaining flexibility in the knee and hip joints, it is important to strengthen those weaknesses contributing to the problem in the first place. A common weakness with runners knee as mentioned before, is the inside head of the quadriceps (vastus medialis). The vastus medialis is considered to be a major stabilizer of the patella, so strengthening it would prevent any detrimental amount of lateral/medial or superior/inferior, patella glide.

One way of doing this would be to lye on your back with the problem leg extended and the other leg bent up with the foot flat on the table. Rotate the extended leg outwards from the hip, lift the toes (dorsi flex the foot) and elevate the whole leg to about 45 degrees, hold for 2 seconds, then slowly lower to the start position and repeat. Do about 2 sets of 10-12 repetitions and increase the sets as necessary.

Don’t forget that the recovery process begins with Active Isolated Stretching (AIS).