Overcoming Knee Pain with Physical Therapy: Boston Marathon Success

Meeting Sarah: A Last-Ditch Effort to Save Her Race

In 2021, I was fortunate enough to meet Sarah. She was intending on running the Boston Marathon in ten weeks but had been sidelined for a month due to knee pain.

After a long 13-mile run, she stumbled and sprained her knee. Further attempts to run after this were met with pain and frustration. She had committed to raising money for the Good Samaritans and was concerned she wouldn’t be able to fulfill this commitment. She came to me in a last-ditch effort to save her race.

During her exam, Sarah experienced significant pain and was unable to tolerate movements like a single-leg squat without aggravating her knee. Given the severity of her discomfort and her difficulty with basic functional movements, I explained that it wouldn’t be advisable to resume running until she could walk, squat, and climb stairs without pain. Fighting back tears, she asked if canceling the race was her only option.

I provided Sarah with all the necessary information: patellofemoral injuries are often successfully treated with physical therapy, but there was a possibility that running could worsen her condition. However, there is substantial evidence suggesting that exercising with some pain can still lead to positive outcomes. Given how important this race was to her, I proposed we test her running on the treadmill to assess whether it might be feasible for her to run the Boston Marathon.


Cadence Modification and Immediate Results

With renewed hope, Sarah eagerly stepped onto the treadmill. Right away, I noticed the classic signs of overstriding: she was landing on her heel well in front of her body, with a straight knee and toes pointing upward. She also reported moderate pain while running.

I recommended we adjust her cadence, which is the number of steps a runner takes per minute. Research shows that increasing cadence by just 5% can reduce the load on the knee joint by over 20%. Sarah was open to trying this approach.

I set my metronome app to 175 beats per minute, and Sarah began matching her steps to the rhythm. Remarkably, within moments, her pain disappeared and the signs of overstriding were gone! After three minutes of running, she remained completely pain-free.

Building a Plan for Recovery

I told her to monitor her symptoms over the next 24 hours. If she felt good, she could proceed with a run-walk routine over the next 2 to 3 weeks. This would gradually expose her knee to more stress and test her ability to handle more intense running.

After a month, everything was going well. I wrote her a three-week plan to progress her long runs from 30 minutes up to two hours. She continued her home exercise routine and performed all her runs. With enthusiasm, she informed me her knee was feeling good. She was going to Boston!


Runner’s Knee

Patellofemoral pain syndrome, often referred to as “runner’s knee,” is a common issue among runners and other athletes. It typically presents as pain around or behind the kneecap, especially when running, squatting, or climbing stairs. The cause can be multifactorial, including overuse, muscle imbalances, or improper running mechanics, all of which we addressed in Sarah’s case.


How Physical Therapy Treats Patellofemoral Pain

When treating patellofemoral pain, a physical therapist will usually focus on:

  1. Strengthening Exercises: Strengthening the muscles around the knee and hips can alleviate the load on the patella (kneecap). This includes working on the quadriceps, glutes, and hip stabilizers to create more balanced force distribution across the knee joint.

    • For Sarah, we included exercises like:

      • Glute bridges to strengthen her posterior chain.

      • Step-ups and lateral squat slides for better knee and hip alignment.

      • Goblet squats to strengthen her quads.

2. Running Gait Analysis and Modifications: As I did with Sarah, observing and adjusting running form is key in reducing the stress on the knee. In Sarah’s case, her overstride was contributing to unnecessary stress on her knee joint. By increasing her cadence, we helped reduce the impact forces on her knee, which allowed her to run pain-free.

3. Stretching and Mobility Work: Tight muscles around the knee can exacerbate patellofemoral pain. We often focus on improving the flexibility of the hamstrings, calves, and quads. Sarah’s rehabilitation plan included daily mobility exercises to ensure her muscles remained supple and didn’t place undue stress on her knee.

4. Taping or Bracing: Sometimes, additional support through taping techniques or bracing is used to guide the kneecap’s movement and reduce discomfort during activity. While Sarah didn’t require this, it can be a useful tool for managing symptoms in some runners.

Patellofemoral pain in runner’s is highly treatable! Every PT on our team has advanced expertise in diagnosing and treating runners—something you won’t find anywhere else in DC. At Norton PT, you’ll get world-class care and the attention to detail you deserve.

If you’ve been dealing with any nagging aches or pains, or just want to make sure your body is ready for race day, we’d love to help. Feel free to reach out and schedule a call to see how we can help!