Knee Pain in Women Runners

Why Is It So Common?
Knee pain is one of the top five running injuries impacting up to 2.5 million runners in the United States. There are many features of this common malady, some of which remain obscure. A number of risk factors have been cited over the years. Some of these factors affect women more so than men.

Female runners frequently experience knee pain on the front of the knee joint around their knee cap, known as the patella. The pain can be anywhere around the knee cap, on either side, above, or below.
This syndrome has been commonly called Runner’s knee. The more commonly accepted medial term is Patello-femoral Pain Syndrome. The femoral part of the description applies to the thigh bone or femur.

Symptoms include pain which occurs during or after running. Commonly the pain is worse when going down stairs or running down hills.

The patella (knee cap) is surrounded by the lower portion of the quadricep muscle on the front of the thigh. The quadricep muscle is actually made up of 4 different muscles (therefore the name). The under surface of the knee cap has a ridge which rides in a corresponding groove on the end of the thigh bone. When the knee bends, the knee cap (patella) should move and slide smoothly up and down in this groove, similar to a train on a track.
With Runner’s Knee or Patello-femoral Pain Syndrome, there is either a dysfunction or disruption of this smooth gliding, tracking motion.

There are several likely causes of this abnormal tracking. An imbalance in the strength or flexibility of the muscles surrounding the knee may be to blame. In runners with this type of knee pain, the muscles on the front and outside of the thigh (your I.T. band vastus lateralis) are often stronger and less flexible than the smaller muscles (vastus medialis) on the inside of the knee and thigh. Since the patella is a part of the quadricep complex, the larger outer muscles may pull the patella sideways and slightly off track.
This problem may be exacerbated in women due to the fact that the femur (thigh bone) is not in the optimal position as it descends down from the pelvis. Women often have wider hips resulting in a larger angle, called the Q angle, as the thigh meets the leg bone (tibia). This condition is commonly called “Knock Knee” or Genu Valgum.

Other reasons that Patello-femoral Pain Syndrome affects so many women, is that they have relatively weak hip muscles which can contribute to a weak core. Therefore, poor control form the hip muscles can cause faulty mechanics at the knee.
Other risk factors which can cause knee pain of this kind in women are abnormal patella shapes which are hereditary, a smaller or larger than normal patella, hyper mobility of the knee cap, tightness in the calf muscle and hamstrings may be a contributing factor as well. The knee cap can also be in an abnormal position in its relationship to the thigh bone groove (it may sit too high or too low in the groove).

Excessive abnormal pronation of the foot, a flattening of the arches of the foot in gait and running, can cause abnormal tracking of the knee cap to occur.
Over training, improper shoe selection, running on canted or uneven surfaces can also contribute to this syndrome.
What can you do to prevent and treat Patello-femoral Pain Syndrome?

Treatment options include core strengthening exercises, flexibility exercises of the hip, thigh, and calf. Custom made biomechanical insoles are helpful to realign the foot posture and protect the structures above form abnormal forces.
Other helpful tips include cross training on a bike, swimming, and an elliptical trainer. Try not to run until pain has subsided and you have corrected your abnormal mechanics. Simple rest alone would cure you but you must correct your abnormal biomechanics.

When you do return, use an easy graded return, avoid speed work, avoid downhill runs or walks, check your shoes to make sure they are the correct shoe for your foot type by checking with a running store nearest you.