Patellofemoral pain syndrome is even more annoying to get than to try to say during a fartlek session. Also known as PFPS or â€˜runnerâ€™s kneeâ€™, it is the irritation of the cartilage on the underside of the patella (kneecap).
About 40 per cent of running injuries are knee complaints and 13 per cent of runners have suffered knee pain in a 12-month period, according to a survey in Runnerâ€™s World magazine.
PFPS typically flares up during or after long runs, after extended periods of sitting down or while descending hills and stairs.
Are you at risk?
Anyone with biomechanical factors that put extra load on the knee is vulnerable to PFPS, according to Dr Bryan Heiderscheit, director of the University of Wisconsin Runnersâ€™ Clinic in the United States. Those factors include overpronation (excessive inward foot rolling) and weak quads, hips or glutes.
Can you run through it?
Yes, but you need to take extra rest days and reduce your mileage. Run every other day and only as far as you can without pain.
Some runners find inclines less painful, so Heiderscheit recommends simulating hills on a treadmill. Running uphill works your glutes: strong glutes help control hip and thigh movement, in turn preventing your knees from rolling inwards. Cycling may speed recovery by strengthening the quads, and elliptical training and swimming are also knee-friendly. Just avoid running downhill, which can exacerbate pain.
Strengthen weak hip and glute muscles with lateral side steps, says physiotherapist Charlie Merrill. Loop a resistance band just above your ankles or knees. Separate your feet and bend your knees to lower into a crouch. Now walk sideways for 10 to 15 steps, keeping your feet straight and upper body still. Maintain band tension throughout, then reverse the direction. When this gets easy, try it on your toes. If thereâ€™s an issue with the way your kneecap tracks, athletic tape may reduce pain. Post-run icing helps in the early stages; heat works best as the injury is healing.
Prevent a relapse
Heiderscheit recommends shortening your stride length and landing with your knee slightly bent, which can take up to 30 per cent of the load off the joint. Count the number of steps you take per minute, then increase by five to 10 per cent. Keep your knee tracking correctly by strengthening its supporting muscles â€“ your quads and glutes â€“ by doing side steps and squats.
2004 Olympic marathon silver medallist Meb Keflezighi had knee trouble in the buildup to the 2014 Boston Marathon. He took two weeks off and ran only every other day for the following two weeks. The strategy worked: he clocked a personal best of 2:08:37 to win the race and add the Boston Marathon title to his impressive CV.
How to proceed
Stop running: Pain on the inside or outside of your knee on waking, which doesnâ€™t ease through the day.
Run with caution: Twinges early in a run that dissipate, then come back post-run. Flares after prolonged sitting.
Go run: Pain-free, even after sitting through a two-hour film or tackling a long hilly run.