What is runner's knee?

In my first blog on runners knee I spoke about iliotibial band syndrome or lateral knee pain. In this follow up blog I’ll be looking at anterior knee pain also known as patellofemoral pain syndrome.

Patellofemoral Pain Syndrome (PFPS) is a common injury faced by runners. It involves the tissue within and around the knee joint between the knee cap and femur (thigh bone). It can be hard to isolate what structures are causing the pain and typically aggravates on loading of the knee.

How to treat patellofemoral pain syndrome?

When working with athletes suffering with PFPS, initial de-loading of the joint is required and key to allow for reduction of the inflammatory response and reduce pain at the knee. Once a cause has been identified rehabbing the joint to correct and deal with the cause allows us to then begin a graded return to running.

So, what has caused it?

Patellofemoral pain (PFP) syndrome is a frequently encountered overuse disorder that involves the patellofemoral region and often presents as anterior knee pain. It can be difficult to diagnose due to the complex structure of the knee and the various surrounding tissues surrounding it. PFPS seems to be multifactorial, resulting from a complex interaction among intrinsic anatomic and external training factors. The 3 major contributing factors commonly discussed are malalignment of the lower limb and/or the patella, muscular imbalance of the lower limb and overactivity.

How to treat PFPS?

1.       Training tissue overload!!!

Whether due to being over eager from a period of little or no training, reaching for previous glory or sticking in some pressure miles and intervals last minute for a looming event. Overloading of the tissue is a common cause for many issues. Initial treatment involves de-loading the tissue from running or resting from running until we are sufficiently pain free or at a point of manageable discomfort where we can re-introduce running and begin a graded increase of volume and intensity.

2.       Muscle weakness

When we talk about muscle weakness in most cases we want to explore and target our Quadriceps  and Glutes.

When addressing the quads, the tissue directly targeted may be quite sensitive. It is important to use pain/discomfort as your guide when progressing load. Knee extensions can be a good tool to manage the load and specifically target the muscles we want to develop and then look at progressing to variations of compound movements to develop the quads with larger movement patterns.  

 Our glute rehab wants to target both the Gluteus Medius and Maximus. The Medius muscle covering hip abduction, can be developed with exercises such as loaded hip abductions or side planks and Maximus, hip extension, can be hit with hip thrust and hip hinging exercises. As with the quadriceps-based exercises it is important to consider how to strengthen without increasing Patellofemoral load and pain. Pain can be a good guide of this so is important to monitor and adjust around your response to exercise.

3.       Poor movement control

Often people will present with a medial knee roll or adduct at the hip (moving towards the other leg) or rotate at the knee placing greater load on the patellofemoral joint. This may indicate poor single leg control which may be a cause of PFPS. Glute Medius is often put down as the culprit, possibly due to weakness or lack of contraction timing along with other muscles around the knee. As we spoke about previously, we can target the glute med to address any weakness but also look to improve control of the limb to avoid the medial roll/hip adduction with the aim of decreasing the tissues around the knee that become painful.

4.       Reduced flexibility

Tightness of the muscles around the knee such as quads, ITB, hamstring and calf muscles can have an influence on how the knee joint functions. Tightness in the ITB is thought to pull the patella slightly laterally (towards the outside of the knee). The quadriceps attach to the patella directly and so any tightness in this muscle will affect the way the this moves. The alterations in the movement of the knee and kneecap therefore have the potential to increase loading and potentially lead to flare up of pain. Working on mobility of the surrounding tissue can potentially offload the knee structures and help to reduce pain, it is important to continue incorporating mobility and working muscles through full range under load once paid as resolved in order to prevent or reduce flare ups in the future.

In Summary

Patellofemoral pain syndrome can be frustrating when it occurs. Managing loading, weakness, flexibility and control of the limb can go a long way to resolving it. Continuing to manage these factors will help reduce likely hood of reoccurrence and see you running more consistently pain free.