Anterior knee pain: the blanket term by professionals for sore knees

Anatomy of the knee

Knee pain in running can be caused by many factors; they can vary from the type of shoe you run in to an injury that happened many years ago. The most common cause of running injuries is overtraining, this is when training intensities are increased too quickly and the athlete’s body can’t cope with the stress it is being put under. Another contributing factor to overuse injuries is incorrect biomechanics. When the body is not moving correctly it overloads certain points in the body making them more susceptible to injury. So when we are not moving correctly and doing too much our body is going to give in at the weakest point and in running the knees are a prime target. I will discuss the two most common causes of knee pain during running. It is important to remember that there are many other causes of knee pain when running that should not be overlooked.

ITBFS (Iliotibial band friction syndrome) 

Where is the pain? This pain is felt on the outside of the knee joint and can refer into the front of the knee.
What causes pain? ITBFS is when the iliotibial band (ITB that runs from the hip down the outside of the leg and inserts just below the knee joint becomes very tight. The increased tension in the band causes the band to become inflamed as it rubs over the lateral epicondyle of the femur. Often the band will thicken over time worsening the problem.The friction causes inflammation on the site of the lateral epicondyle. Pain is not always felt during exercise.

It is possible for an athlete to exercise pain free and for the pain to increase afterwards. Conversely the pain can be so debilitating during training the athlete has to stop. 

How do I fix it? As ITBFS is caused by having a tight ITB, the tension needs to be released. Fascial release by using a foam roller or manual therapies are crucial to reduce the tension caused by the ITB, thus relieving the pain and the athlete is able to continue running. Incorrect biomechanics when running can cause the ITB to tighten, so it is important that corrections are made if necessary.

Patellofemoral pain

Where is the pain? Pain is located in the front of the knee, in, under or around the knee cap and it is very difficult to pin-point the specific site if pain.

What causes the pain? Runner’s knee is the most common cause of anterior knee pain. This is when there is increased friction between the patella and the femur. The increased friction causes inflammation of the cartilage which would usually allow the patella to glide effortlessly through the groove in the femur. Patellar tracking, when incorrect, can cause patellofemoral pain as there is an increase in friction in a particular point in the joint. A traumatic event, like pumping the knee cap, can have an effect on the tracking of the patella and can lead to patellofemoral pain.

How do I fix it? A few things need to be addressed when dealing with patellofemoral pain. Reducing the tension between the patella and femur will decrease the friction caused during exercise. The decrease in friction will allow the patella to move freely. Biomechanics of the athlete also need to be assessed, to see what is causing or contributing to the problem, and corrected.

A good strength base in the hamstrings, abductors, and glutes (by training them functionally) along with strong quadriceps coupled with a strong abdominal corset to stablise the pelvis; will aid in minimising stress on the knees during movement.

To make sure that one can get into running and avoid the possibility of knee pain there are a few steps they should follow. If they have never run before then a biomechanical analysis will help identify any possibly risk factors for the athlete. A good strength base will make sure that form is maintained during running, again reducing the risk of injury. Possibly the most important point is to never overtrain. From the onset of running an athlete shouldn’t increase their running distance by more than 10% per run per week. Remember – running injuries can all be avoided if these steps are followed.

Remember that the simplest exercises that make the most difference. Often Bootcamp, Crossfit and other group training forums don't pay enough specific attention to the form required to strengthen the right stabilising muscles.