Knee pain can be the bane of a dedicated runner’s existence.
According to a study published in the British Journal of Sports Medicine, nearly half of all running injuries are centered at the knee. Increasing numbers of Americans are getting knee replacements every year. While rest and strengthening exercises are the best way to alleviate knee pain, it is a problem that can recur again and again no matter how careful you are.
For many runners, a supportive knee brace often seems like an answer to persistent knee issues. Braces vary in level of support and complexity, and can provide the peace of mind that you have taken an extra step to cure your ailment.
However, there are many studies that have shown that strapping a knee brace on an achey joint only masks the pain, with the causes and cures lying deeper in the muscles. While you don’t need to rule out a brace entirely just yet, read on to find out what else can be done to get to the root of your knee pain.
Patellofemoral Pain Syndrome
Because it is the most common source of knee pain, this article will focus mostly on relieving Patellofemoral Pain Syndrome, or PFPS. You might already be acquainted with it as “Runner’s Knee.” The pain experienced can either be sharp and sudden, or dull and throbbing. Sufferers will feel tenderness around the patella, and perhaps the sensation that the knee is giving out.
PFPS is caused by stress where the patella, or kneecap, rubs against the thighbone laterally. Normally, the patella moves vertically against the femur bone, but an imbalance of strength in the vastus lateralis and vastus medialis oblique muscles of the quadriceps will pull the patella side to side instead. Tight hamstrings can also contribute to misaligning and pressuring the patella and femur. The hips become unable to adequately control leg motion and the runner can lose form, making it more difficult to recover.
There are also some biomechanical causes of PFPS that do not have to do with the muscles, such as the shape of the patella, the amount of cartilage in the knee joint, and the flatness or high arch of your foot.
An excellent comprehensive website about the causes, symptoms, and what to expect while recovering from PFPS can be found over at Physioworks.com.
Please do not use this article or any internet source as your sole form of diagnosis or self treatment—your doctor is the best resource for diagnosing your condition and prescribing recovery plans.
Other Triggers of Knee Pain to Look Out For
The knees are a connection of several bones, and many muscles, tendons, and ligaments. The repeated force they receive during running and other sports can cause many conditions separate from Patellofemoral Pain Syndrome. Although the many symptoms you can acquire are unique from PFPS, many sufferers will simply lump them all together under the Runner’s Knee umbrella. Here are some of the other knee afflictions you may be experiencing, although none of this information is as valuable or comprehensive as a physician’s insight.
IT Band Syndrome (ITBS) is a form of tendonitis caused when the Illiotibial Band, which is a tendon that runs from your hip past the patella and attaches to the shin bone, is overworked and inflamed from rubbing against the end of the thigh bone. This article compares the symptoms of ITBS with those of PFPS: for instance, ITBS pain is usually on the outer side of your knee rather than the knee cap.
Another form of tendonitis that causes knee pain is Patellar Tendonitis, which is separate from PFPS (although those with Runner’s Knee can be predisposed to tendonitis). The patella tendon attaches the quadriceps to the shin bone, or tibia. Overuse of the patellar tendon combined with poor alignment of the tendon and kneecap cause pain.
Patellar Tendonitis pain is usually felt lower down on the kneecap than Runner’s Knee, which is felt higher on the kneecap. The earliest signs of tendonitis are usually pain or stiffness.
My Knees Hurt: What Should I Do?
If have not experienced Runner’s Knee yet, there are some basic steps you can take to head it off. Don’t train too intensely or too quickly. Gradually work in hills and longer distances into your training, adding less than 10% of mileage per week. Make sure that your shoes are supportive and that you have orthotics if needed. Replace sneakers as they are worn out.
Whether you are a beginning jogger or a seasoned runner, at the first signs of pain you should cut back on your training. Run less miles, and avoid slopes or excessive stair usage until the pain goes away. If you have swelling or an injury, follow the PRICE plan:
- Protect your knee
- Rest the injury
- Ice the pain
- Compress the area gently with a bandage to prevent swelling
- Elevate the leg
If the pain returns after you slowly begin training again, you should see your doctor. Your physician will help determine the whether it is Runner’s Knee, ITBS, or another issue that is slowing you down.
Should I use a Knee Brace?
Your physician might recommend that you use a knee brace. The two most common kinds of knee braces are the knee sleeve which has no holes, and the patella brace, which has a hole in it over the kneecap. The knee sleeve is compressive and helps to reduce swelling by keeping blood flowing around the patella. The hole in the patella brace attempts to keep the kneecap from moving around in ways that it shouldn’t.
Many people think that strapping on a knee brace will solve their pain problems, but this may not be true. The first reason is that your pain may not be caused by PFPS. As stated above, ITBS and tendonitis cause knee pain, as well as arthritis and a torn ligament or meniscus. If this is the case, purchasing a brace which focuses on the kneecap will not help the pain. This is why you should first see a doctor to determine the source of your injury.
Another reason why a knee brace alone won’t relieve the pain is because if you have Runner’s Knee, the discomfort is probably stemming from the tightness and weakness of the hamstrings and quads as explained above. The knee brace or sleeve may offer temporary relief or prevent the injury from getting worse by increasing blood flow and offering ligament support. However, it is widely accepted that the best way to combat knee pain is to build up the muscles that are causing the patella to track irregularly. Strengthening these muscles will cause them to act as an internal brace and realign the kneecap.
There is some evidence to support the idea that a knee brace is not necessary if you properly stretch and strengthen your quadriceps and hamstrings. A research study by Dutch physicians examined participants with pain who used a knee brace combined with physical therapy and compared them to those who used physical therapy alone to heal them. The study concluded that the knee brace combined with physical therapy was not significantly more effective at alleviating knee pain than a regimen of physical therapy alone.
After consulting with your doctor, you may have a plan to just do exercises to lessen your joint discomfort. He or she may also recommend a knee brace to additionally support the injury. We have outlined some exercises and some knee brace options for your reference below to help you follow whatever your physician’s advice may be.
Stretches and Strengthening Might Be Better than a Knee Brace in Some Cases
Whether your physician recommends you wear a brace or not, if you have Runner’s Knee or another condition it is very likely that he or she will recommend you add in stretches and new exercises to your routine.
The key areas to target are the quads and the hamstrings. Quad strength is key to pain free knees—an Australian study found that participants with stronger and larger quad muscles were less likely to need knee surgery, as well as having less pain and a lower loss of cartilage in the joints. Try doing these quad stretches several times a week to strengthen these muscles.
A related area to target is the hips, which should be strengthened to properly control leg motion. You should also integrate hamstring stretches to loosen the muscles that can stress the patella. There are many IT band stretches that can be done if tendonitis ails you, and your physician may recommend doing some exercises with a foam roller.
In addition to these specific stretches, it is recommended to add swimming, cycling, or Pilates into your exercise regimen. These workouts will increase your leg muscles without putting trauma and stress on the knee the way running can.
Determined to Use a Knee Brace for Running? Here are some good options
If your doctor recommends that you start using a knee brace, it is likely that he or she will point you in the direction of an orthopedic physician. These sports medicine specialists are the best resource for determining what kind of knee brace you will need, and this article is merely an outline of some of the products available. It’s not recommended to purchase a knee brace online unless you have first talked it over with your physician or orthopedic specialist.
The type of knee brace you will be prescribed will depend on the diagnosis of your knee pain and the level of support you will need. For wading through the options out there, the website Knee-Pain-Explained is very informative and offers comprehensive reviews of knee braces and bands. Braces are organized by level of support and complexity, by type, and even by brand to help you locate the best product for your condition.
Basic Knee Brace
The least complex type of brace is the basic knee brace. This brace is often just an elastic sleeve or simple Velcro wrap that can be used after minor strain or injury or with long-term mild pain. They come with and without patellar openings. The basic brace is often universally sized and the least expensive. If you are prescribed this type of simple support, the doctor may recommend you purchase a brace at a sporting goods store or even your local pharmacy.
Advanced Knee Brace
Advanced knee braces are usually more structured and supportive than the basic brace, although they can come in a sleeve or wraparound design. They are used after injury or with moderate chronic discomfort.
Elite Knee Brace
The most complex knee braces are referred to as elite or professional braces. Elite braces offer maximum support for knees. They are often prescribed after knee surgery or cartilage tears and for other severe recurring conditions like arthritis. Professional braces usually have hinges which prevent the knee from moving side to side or hyperextending.
As a general rule, you should expect to pay more as the knee brace you are prescribed becomes more complex. Simple sleeves can cost as little as $10, while elite braces can cost upwards of hundreds of dollars.
Don’t Let Knee Pain Kill Your Enthusiasm for Running
Knee pain can certainly be a deterrent from your running regimen, but it doesn’t have to stop you for good. A discussion with your doctor about other exercise and brace options is the best place to start when you first experience pain.
Preventative measures like strengthening and stretching exercises can help alleviate Runner’s Knee and support the patella. Most importantly, do not ignore your pain or injury and jump back into training right away. Reintroduce speed, hills, and mileage gradually—in the end, slow and easy does win the race!