RUNNERS KNEE Really a catch-all term, this refers to pain in and around the knee cap or "patella." This odd shaped bone is really an integral part of the quadriceps muscle on the front of the thigh. This large muscle is very active in running, especially when going downhill. The patella rests in a groove on the femur and acts as a fulcrum to improve the angle of pull of the quadriceps muscle which attaches to the lower leg bone (tibia) through a thick tendon called the patellar tendon. The early symptoms are usually a dull aching in and around the patella, after running. There may be a stiffness in the knee as well, partly due to a swelling of the inflamed tissues. Depending on the biomechanics of the individual runner, the pain may be localized to one area or another of the patella. If the pain is localized to the patellar tendon it is often referred to as Patellar Tendonitis. If the biomechanics of the runner are such that the patella does not sit properly in its femoral groove, the underside of the patella will over time wear down and become rough and deteriorated. This condition is known as Chondromalacia Patella. As in most cases of inflammatory processes, left untreated the symptoms generally get worse and over time deterioration and /or scarring of the involved tissues takes place. PROBABLE CAUSES tight quadriceps muscles, tight calf muscles (hamstrings may also be tight) biomechanical faults (usually excessive or prolonged pronation), worn or improper shoes training errors (too much hill work too soon) TREATMENT STRATEGIES stretch tight muscles (quadriceps and calf muscles) examine shoes for wear and replace frequently, ICE (several times a day for ~ 10 minutes) Rest, and reduce hill work and speed work ,see a biomechanical specialist for comprehensive assessment, gait analysis, and treatment Orthotic devices to control the biomechanical abnormalities causing the knee pain.