Problem: My Knee Aches


Thursday, August 5, 2004, 12:00 am

Q: Do you feel stiffness over the front or inner side of your kneecap, especially after sitting or kneeling? Does it hurt more walking down steps? Does the pain go away a few minutes into your run?

If the answer is yes you could be having Patellofemoral pain, see [A] below.


Q: Is the outside of your knee achy, stiff, or tender? Do you run on a track regularly? Does it hurt during long runs and then fade afterward? Are you training for a marathon?

If the answer is yes you could have Iliotibal band syndrome (ITBS), see [B] below.

Q: Is the pain in the front of the knee below the kneecap? Does it get worse as you run? Have you recently added more mileage? 

If the answer is yes you could have Patellar tendinitis, see [C] below.

Q: Do you feel achiness under your kneecap? Is your knee swollen? Have you logged more than 400 miles in your shoes?

f the answer is yes, you could have Osteoarthritis, see [D] below.

[A] Patellofemoral pain can be caused by alignment problems, damage to kneecap cartilage, overpronation, or muscle/tendon weakness or tightness. You can run through most patellofemoral pain, says Robert Wilder, M.D., of the University of Virginia, but you may need to cut back on distance, hills, or intensity. (But be extra careful if you have chondromalacia, a form of arthritis that causes patellofemoral pain.) Strength training, wearing a knee brace, taping your arches or wearing an orthotic, and replacing worn shoes or wearing motion-control shoes can help.

[B] Iliotibal band syndrome (ITBS) occurs when the IT band, which runs from the buttocks down and across the knee becomes tight and inflamed. Overpronation and bow-leggedness can also contribute. If caught early, you can recover in one to four weeks. Take anti-inflammatories one to two hours prerun, and stretch and ice postrun, says Irene Davis, Ph.D., P.T., of the University of Delaware. Reduce mileage, hills, and intensity. When you run on a track, rotate laps (1 mile clockwise, 1 mile counterclockwise). Tape your arches or wear orthotics.

[C] Patellar tendinitis is inflammation of one of the knee-joint tendons. Tendinitis occurs when tissue breakdown outpaces regrowth, and is caused by increased mileage, hills (especially downhills), and pace. Running through tendinitis will make it worse and prolong your recovery, says Davis. But treated early, it can heal in a few weeks. Here's how: cross-train, ice, wear a patella strap, take anti-inflammatories, stretch, and do exercises to strengthen the joint and quadriceps, such as leg extensions.

[D] Osteoarthritis is the wear and tear of cartilage. The pain can flare up on a run or a leisurely walk, depending on the severity and your age. Good news: Moderate running is okay, Wilder says. Cut back on mileage, hills, and pace when symptoms occur. Consider getting new shoes after 300 miles instead of 400 to 500 miles. Include a good strengthening program that focuses on hamstrings, quads, shins, and gluteals. Wearing a knee brace and taking nutritional supplements of chondroitin and glucosamine also are recommended.