Let’s first start with a bit of a clinical understanding of this type of injury. The patient experiences gradual onset pain at the knee that begins with prolonged weight-bearing exercise, such as running. The longer they exercise, the more intense the pain gets, to the point where they have to halt the exercise. The pain can be located medially (inside), laterally (outside), or throughout the entire knee joint. Swelling is uncommon, but can be present upon exercise completion. Clicking in the knee is often experienced, but is typically painless. Non-weight bearing exercise, such as swimming or biking, usually do not aggravate the pain and can be performed without limitation. Applying home therapy protocols such as ice and/or heat over the knee often do not help address the problem. The pain usually settles down shortly after exercise is completed, but some patients do report ongoing pain with walking for 1-2 days after exercise.
When this type of clinical picture presents during a consultation, I immediately start to question the patient as to what has changed in their daily activity and exercise regimens. When injuries occur gradually, compared to an acute onset that brings pain on immediately such as a sprained ankle, we have to try to identify what factors would have led to dysfunction in the body. Injury doesn’t occur without a reason behind it. When pain builds gradually, it usually means that something has led to the body not being able to accommodate that change from a functional movement perspective. The possibilities of such changes are endless – changes in footwear, in training intensity, in training volumes, in training terrain (road vs. trail running), in the body’s hydration, and changes in activities of daily living, such as an increase in sitting throughout the day. Any and all of these factors can lead to a new stress on how the body moves, which can eventually lead to dysfunction in the tissues, such as the muscles, fascia (connective tissue), and joint capsule. Once dysfunction develops and goes unaddressed over a period of time, the body is at increased risk of developing pain and injury.