GP Paul Stillman of Talking Knees recommends what to do treatment-wise and rehab-wise if you’re suffering knee pain while running

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Runner’s knee is an inflammation of the cartilage principally on the back of the kneecap. Inflammation occurs from overuse. Training too hard or progressing too quickly without preparation, inflames the joint and produces an effusion (fluid) inside the joint that pushes the patella away from the femur and unseats its position. Symptoms are pain and often swelling. The pain in the front of the joint around and behind the patella can be acute – sharp and usually precipitated by movement, or chronic – duller but almost constantly present. When established, almost any activity can set it off, including bending the knee, rising from a chair, squatting or kneeling. A give-away sign is sharp pain when coming down stairs.

Mechanical stresses are important. The quadriceps muscles are amongst the strongest in the body, and if not perfectly balanced misalignment of the knee joint can pull the patella fractionally out of place. The condition is more common in women, probably because the wider pelvis causes the femur to join the knee at an angle. Injury in the back or feet can also contribute.

Rest, in the acute stage, is essential. Ice packs, a knee support and perhaps antiinflammatory medication may all help, but you cannot return to exercise until it has settled
and then only with steady progressive rehabilitation. If pain recurs, you are probably doing too much too quickly. The impact should also be kept as low as possible to start, for example, training on grass before getting back to roads.

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Physiotherapy, rebalancing and retraining the muscles progressively using a range of exercises, inflammation control and hydrotherapy, is a mainstay of treatment. Correcting biomechanical stresses is vital to prevent recurrences and there are specific treatments such as AposTherapy that can help. In this treatment, chartered physiotherapists analyse your gait and the strain through the knee and provide an individually-calibrated foot worn device to bring the body to optimal alignment, reducing the pressure and strain on the joint.

Full training should wait until you can stand, walk, and straighten your knee fully without pain. Permanent damage to one or both knees is a long-term consequence if untreated, so pay close attention to your knees and seek treatment as soon as you notice irregularities.

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