I was interested in the query you dealt with last week from a runner who developed a problem with his foot. I recently took up jogging and am now having difficulty with my knee. At first I noticed a pain just below my kneecap only when I ran downhill, but now even walking down steps is painful. Any suggestions as to what this could be?
It sounds very like runner's knee, a condition that is also known as patellofemoral stress syndrome. The kneecap is a circular bone that is attached to ligaments and tendons around the knee. It normally moves slightly up and down without touching the end of the femur, the thighbone, when walking or running. In runner's knee, however, the patella rubs roughly against the end of the femur.
Why does this happen?
It can occur for a variety of reasons including a structural defect where the kneecap is located too high or too low in the knee joint, off centre insertion of the muscles of the kneecap, weak thigh muscles, tight hamstring muscles or Achilles tendons. Weak thigh muscles are the most common treatable cause of runner's knee. These weakened muscles allow the kneecap to move sideways and rub against the thighbone causing pain. Another common treatable cause is excessive rolling of the feet onto the outside (pronation) when walking or running. The force of this action causes the bony patella and the end of the femur to grate against each other causing pain.
What can I do about it and will I have to give up exercising?
Before you do anything else you should make an appointment with your GP to confirm the diagnosis. If the pain is severe, a course of non-steroidal anti-inflammatory drugs may be prescribed in addition to rest, ice packs and gentle exercises. It is advisable to refrain from jogging or running until they can be undertaken without pain.
While your knee is still painful, you should consider undertaking other types of non-weight bearing activities such as cycling or swimming. Exercises to stretch, tone and strengthen tight muscles will help but I'd advise that you consult a qualified physiotherapist before embarking on them; if done incorrectly, they may exacerbate the problem further.