Runners Knee: Treatment Options

author : AMSSM

comments : 1

Here are several treatment options for runners knee presented from the least invasive to the most invasive.

Member Question

"After a half marathon I felt pain under my kneecap, upon a medical examination the consultant said that I have bone cartilage wear and tear. He advised me to do a laser therapy with infiltrations of hyaluronic acid.

I would know your opinion about the real efficacy of those treatments because some find them absolutely ineffective.

Nowadays I am taking a supplement of glucosamine and doing strength training. Could this be enough?"

Answer by Sara Brown, DO
Member AMSSM

It sounds like you have a condition called chondromalacia of the patella = the wearing of the cartilage under the kneecap.  This condition is also referred to as patellofemoral pain or “runner’s knee”, as it is very common in runners. 

The cause of this condition is multifactorial, but in general involves a lack of control of kneecap tracking.  Weakness in your core/hips/quadriceps, tension in hamstrings, and ankle instability can all contribute to this maltracking.  If the kneecap does not track well, it will rub against the ridges of the femur and that wears down the cartilage underneath. 

There are several treatment options for this and I usually present them from the least invasive to the most invasive. 

Exercises to stabilize the kneecap are very helpful for decreasing pain acutely, but also for long-term results and prevention of progression of the condition.  There are a lot of exercises to consider and they can be done incorrectly, so I typically recommend enlisting the help of a physical therapist. 

There are a few ways to artificially improve the kneecap tracking, such as taping (which your physical therapist can do) and a brace (typically I recommend a J brace).  These are meant to be temporary measures.  Ice can help decrease the inflammation surrounding the kneecap.

If there is a lot of irritation and/or if it is not responding to the above measures, I will offer medications such as anti-inflammatories or other pain relievers.  These are meant to be temporary as well. 

An over-the-counter supplement called glucosamine chondroitin is very safe to take, but has mixed reviews regarding pain relief.  It can take 2-3 months to notice effects from taking this, so I recommend taking it consistently for that long to give it a good trial. If you are wondering whether or not it is helping, you can stop taking it for 1-2 weeks to see if pain returns.

Laser therapy is also not invasive, so it may be an enticing option for people trying to avoid injections and surgery. The use of laser therapy for chondromalacia of the patella has demonstrated inconsistent effectiveness in the literature.  So, the jury is still out on that one.

Injections are also a treatment option. To decrease pain and inflammation, steroid injections can be very helpful. If too many steroid injections are performed, however, this can potentially damage the tissues in the joint, so this should be minimized and only used in situations of extreme pain. 

The other injection option is hyaluronic acid.  This injection is meant to produce cushion and lubrication in the joint.  This has also demonstrated variable results. Some people find it very effective for reducing their pain, while it does nothing for others. 

Typically, I recommend approaching this in a step-wise fashion, starting with the least invasive options and working up from there.  I also stress the importance of exercise to improve the kneecap tracking.  You may not want to try too many things at once because then you won’t know what has worked.

Sara Brown, DO
Chicago Primary Care Sports Medicine
Chicago, IL

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date: April 18, 2012