7 July, 2020 Dr Ardy Quek

Runner’s Knee: A TCM Approach

Runner’s Knee is a set of symptoms most commonly seen in long-time runners. It is characterised by pain in front of the kneecap, sometimes spreading to the sides or the back of the knee, which worsens when walking downhill or down the stairs. 

The pain can also manifest as a sharp “clicking” pain while bending and straightening the knees especially during exercise. With the introduction of more trendy aerobic exercises like HIITs, spin classes, MMA gyms and the like, there has been a significant increase in patients suffering from Runner’s knee.

Causes of Runner’s Knee

Runner’s knee can be caused by both pre-existing conditions or acquired factors. Some people are born with weaker knee joints, causing misalignment of the bones. This can lead to uneven distribution of body weight during strenuous exercises. As time passes, this can lead to subluxation of the knee joints and cause chronic pain that worsens especially after exercising.

Other acquired factors are listed as below:

1. Repetitive bending of the knees during strenuous exercises.

Repeated bending of the knees can cause the muscles and soft tissues surrounding the knee joints to become irritated and inflamed.

2. Direct trauma to the knee

A direct hit to the knee can happen during a fall or a blow (e.g. a low kick to the knee during muay thai). Pain from traumatic forces may or may not be accompanied by swelling in the knee joints.

3. Asymmetrical development of thigh muscles

Unbalanced development of thigh muscles may cause the position of kneecaps to differ on both knees. This will lead to uneven distribution of body weight in both knees and cause one side of the knee joint to suffer from more wear and tear.

4. Difference in leg length or rotation

A difference in leg length or rotation can be caused by various factors such as flat feet, misaligned hip joints or SI joints, uneven tension of back and gluteal muscles and so on. Uneven distribution of body weight arises from such factors and may cause pain in the knees.

5. Chondromalacia patella

Chondromalacia patella (CP) is a condition where the cartilage beneath the kneecap breaks down. CP can both be a cause for runner’s knee or as an end result from Runner’s knee.

Prevalence of Runner’s Knee

Runner’s knee can be present in all age groups with a higher prevalence among athletes and middle-aged women. 

Some growing children will go through a stage of “growing pains” associated with Runner’s knee as the muscles and joints develop. 

In young adults, Runner’s knee usually manifests as pain on the kneecaps which worsens with strenuous exercise.

For middle-aged women, due to rapid loss of calcium from the bones and gradual degeneration of the lumbar and hip bones, Runner’s knee can manifest in simple movements such as squatting or walking down the stairs. 

Once chondromalacia patella begins, most people with runner’s knee begin to experience pain even while resting and especially at night, leading to restless sleep and perhaps even depression. “Clicking” pain and swollen knee joints may also be present at this stage.

Treatment of Runner’s Knee

Non-surgical options include oral painkillers and physiotherapy. Painkillers can help with the painful symptoms but they cannot remove the root cause. Physiotherapy and muscular strengthening can fully reverse the symptoms of early to mid-stage Runner’s knee. Below are a few simple exercises to strengthen the muscles around the knee joints.

1. Single leg knee raise

Stand with both legs shoulder width apart and lift one knee. Maintain a 90° angle at the hip and knee joint and hold for 1 minute. Repeat for both legs.

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2. Double calf raises

Stand with both legs shoulder width apart and lift both heels up. Engage the calf muscles while keeping both legs straight. Maintain the position for 1-2minutes.

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3. Lying quad squeezes

Lie down with both legs straight. Engage the quadriceps for both legs and “squeeze” the kneecap downwards. Squeeze for 2 seconds and release slowly for 2 seconds. Repeat for at least 20 times per side.

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Late-stage runner’s knee is usually associated with chondromalacia patella. Surgery may be required to restore functions to the knee joints.

TCM Treatment of Runner’s knee

TCM treatment of Runner’s knee revolve around promoting better blood circulation to the knee joints and stimulation of nearby muscles. 

Acupuncture treatment can be used to either loosen up the tightened muscles around the knee joint or to directly stimulate the removal of inflammatory materials within the joint. Stimulation of certain acupoints can promote more blood flow towards the knee joint and nearby muscles, directly promoting soft tissue repairs to happen. Tuina therapy may be included as a supplementary treatment for acupuncture for more serious cases of Runner’s knee.

Certain herbs may also be used orally or externally to further improve the efficiency of treatments.

Prevention of Runner’s knee

  1. Prioritise correct form and posture while exercising. (Don’t geh kiang)
  2. Do not neglect strength training for lower body muscles. (Don’t skip leg day)
  3. Maintain a healthy body weight. (Time to lose those extra kilograms, refer to our weight loss program)
  4. Understand that certain exercises can no longer be performed after a certain age and look for safer alternatives. (Don’t haolian)

Should you suffer from the above conditions, feel free to make an appointment with your nearest PULSE TCM Clinic.

Note: Information provided is not a substitute for a physician or any form of medical care. Individual symptoms differ due to different body constitutions and diagnosis. One should consult a licensed TCM practitioner for accurate diagnosis and treatment.

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About the Author

Dr Ardy Quek

Dr Ardy Quek

Consultant Physician

Doctorate in Acupuncture and Tuina for Pain Management (Guangzhou University of Chinese Medicine, China)

Bachelor of Science in Biomedical Sciences (Nanyang Technological University, Singapore)

Bachelor of Medicine (Chinese Medicine) (Beijing University of Chinese Medicine, China)

Dr Ardy Quek graduated in 2012 with double degrees from NTU & BUCM. During which, was mentored by the Chief Physician of the Tuina & Pain Management Department in BUCM-affiliated Dong Fang Hospital.

Experienced in pain management, Dr Quek is skilled in treating acute/chronic pain using acupuncture and tuina. He is also adept at diagnosing and treating various muscular and skeletal diseases, and applying the “Abdominal Vibration Therapy” for digestive (IBS, Indigestion) and menstrual (Endometriosis, PCOS) issues.

He chose to pursue his doctorate in the field of pain management, with an in-depth analysis of treating migraine using TCM methods; and has obtained an IPMA (International Pediatric Massage Academy) certificate for Pediatric Massage.

Dr Quek’s expertise: Sports Injury, Pain Management, Migraine, Myofascial & Joint Manipulation, Pediatric Massage