Ask the Pharmacist

Q) I get this dull, aching pain right just behind my knee cap whenever I go up or down the stairs. Any idea what’s wrong?

A) While this pain might be a result of any number of muscular or skeletal injuries, it certainly sounds a lot like a condition that we commonly refer to as runner’s knee. The medical term for this injury is patellofemoral pain syndrome.

The hallmark symptom is pain at the front of the knee, around or just behind the kneecap which usually occurs during movement although it may also happen after prolonged sitting as well. It tends to feel more like an ache if it occurs when you are not exerting yourself. When exercising, it will usually become a more intense ache and it may progress in some to a very sharp pain.

Certain movements may cause a grinding or crunching sensation within the knee as well. This is known as knee crepitus and this tends to occur when first moving the knee after an extended period of rest such as getting out of bed first thing in the morning. This “feeling” tends to go away with movement, as opposed to the pain sensation.

Some may also hear popping noises emanating from their affected knee particularly when they are moving upward or downward (such as on stairs or a hill) or when performing an activity that requires squatting. The front of the knee may swell with excess fluid (the swelling will feel soft as if there is water around the joint) which may limit the knee’s range of motion.

People with runner’s knee also tend to find that their knee gets quite stiff after extended periods of sitting with the knee bent such as after a long car ride. The cause of all these symptoms, to put it simply, is one of alignment. In people with alignment problems (such as in those who are bowlegged, or whose knees sag inward), the kneecap can’t smoothly follow its vertical track (called the trochlea) as the knee bends and extends. This, over time, causes wear and tear on the joint resulting in the symptoms as described above.

Factors that can contribute to this initial misalignment may include weak or tight thigh muscles, flat feet, increased body weight, inadequate stretching before exercise, overuse, and a number of injuries or disorders of the knee such as a dislocation, arthritis or a fracture. Perhaps surprisingly, it is seen more commonly in women than in men and tends to be seen more in middle age and older adults rather than in the younger generations. This is undoubtedly a reflection on the fact that this is a gradual “wear and tear” type of disorder as opposed to an acute injury like a sprain.

Not surprisingly, we tend to diagnose runner’s knee in people who tend to very active. A diagnosis is usually made by your physician based upon a complete history, physical examination and possibly a scan such as from an x-ray, CT or MRI. Treatment always begins, as do almost all other muscular injuries, by following the RICE formula which is:

  • Resting the knee as much as is possible,
  • Ice – apply frequently for short periods of time,
  • Compression – wrapping the knee with a sleeve or elastic band 
  • Elevate the leg to reduce swelling.

Mild pain medications such as Tylenol/ acetaminophen or an anti-inflammatory such as Advil/ ibuprofen or Aleve/ naproxen can be taken if needed to control pain. Once the pain and swelling are under control, you should be prescribed specific exercises and stretches focusing on the muscles and connective tissues around the area in order to restore the knee’s strength and range of motion.

Shoe inserts may benefit some who have abnormal foot structures or movement patterns when they run. A knee brace or taping to maintain proper tracking of the kneecap may also be helpful for many. Rarely, surgery may be required if the cartilage within the kneecap is sufficiently damaged or if the kneecap needs to be realigned.

The American Academy of Orthopaedic Surgeons suggests the following to prevent runner’s knee from reoccurring (or occurring in the first place) -keep your weight under control

-do a 5 minute warm-up, followed by stretching exercises before engaging in strenuous activities

-gradually increase the intensity of your workouts

-buy proper running shoes that fit your feet and change them when they start to wear out

-use proper running form (yes, there is a correct way to run) and avoid running on hard surfaces such as concrete.