Patellofemoral Pain Syndrome (Runners Knee)
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Runner’s knee is a painful condition affecting the joint at the front of the knee, the patellofemoral joint. This is the joint between the patella (the knee cap) and the femur (thigh) bones. This is a painful condition caused by irritation and inflammation of the back surface of the patella. It is caused by repeated bending and flexing of the knee under load or because of biomechanical factors that cause poor alignment of the patella. In some sports this injury is more prevalent, such as running, hence the name. But also sports that involve a lot of jumping, squatting or kneeling. You can read more about this in the related article: Patellofemoral Pain Syndrome (Runners Knee).
Firstly a confirmation of the diagnosis must be attained, as there are several other causes of anterior knee pain that can present similarly. Seeing a physical therapist for an assessment is a good place to start. Next, the specific cause of the runner’s knee condition should be understood. Treatment will depend on the causes, and contributing factors and what activities the individual does or what sports they play.
This condition is commonly caused by a combination of factors including biomechanics and training errors. Biomechanical factors can include muscle strength and flexibility, muscle firing timing, foot and hip posture and control.
Addressing the relevant factors is essential, and a physical therapist is best to guide you through this process.
Physio can offer a broad range of treatments to help recovery from runner’s knee. In the early and most painful stages, massage and advice on stretching or foam rolling will be the most effective. In many cases of patellofemoral pain syndrome tightness of the quadriceps muscle, specifically, the lateral part can play a large role in this condition’s development or persistence. Massage, foam rolling and static stretching can be very effective to reduce this tightness and can help the alignment of the patella. In some cases, people respond well to acupuncture for pain relief and to reduce tension in muscles.
In addition to relaxing the muscles, there may be weakness or poor firing patterns in other muscles. Assessing the movement of an individual as well as their strength through different movements of their knee, hip and ankle will guide what specific exercises will be helpful. Rehabilitation exercises should focus on your specific needs.
Related article: Runners Knee Exercises
If the gluteus medius and minimus muscles are weak they will not control the inward movement of the thigh when walking, running or squatting and this can put much more pressure on the patella and cause pain behind the knee cap.
There are four muscles that make up the quadriceps group. It is common with PFPS to see a tightness or overactivity of the vastus lateralis, and weakness or slow firing pattern to the vastus medialis muscles.
With prompt and accurate diagnosis and appropriate treatment, the healing time for runners knee is 4-6 weeks. However, it can be difficult to know how long to rest. A good guide is to use pain intensity. As this condition is an irritation of the patella, and it causes inflammation of the joint surface. Therefore, pain should not be tolerated and ignored.
Some rehabilitation exercises will require tolerating low pain but these should be carefully monitored. Pain that is caused by movements and activity that is not directly improving the necessary strength or flexibility of muscles, in order to recover should be avoided as much as possible. The more frequently, that this pain is experienced the longer recovery can take. Relative rest is therefore very effective. That is resting from or reducing, volume or intensity, of aggravating activities but keeping active and working on specific rehab exercises.
Neither ice nor heat will hugely impact recovery time. However, as patellofemoral pain syndrome causes an irritation, inflammation and pain at the back of the patella, ice can often feel more comforting and pain-relieving than heat.
Surgery and other invasive interventions such as injections are rarely necessary, nor effective for the treatment of patellofemoral pain syndrome. Only in extreme cases of patella malalignment might surgery be offered.
Non-steroidal anti-inflammatory medications such as ibuprofen can be more effective for PFPS pain as they can target the inflammatory process. However, inflammation is necessary for the early stages of the healing process. Therefore, NSAIDs should be avoided for at least the first 48hours after injury.
Joint supplements are a huge industry but for many, there is little evidence that they work as advertised. Some, such as Glucosamine, have extensive research that shows positive benefits to joint health. The quality and quantity of the product impact efficacy. Always consult with your general practitioner or pharmacist.
Prevention of any condition will come from understanding what makes up efficient biomechanics for the activity or sport undertaken. This is the necessary strength, flexibility, stability and control needed. And in many cases strength and conditioning will reduce injury risk. Some strength and conditioning will focus as improving the capacity of the tissues used in the sport and other exercises will focus on maintaining balance by strengthening the muscles that are used less and might therefore before weak.
Additional tips for prevention include gradual incremental changes in training such as running distance, frequency or intensity, and ensuring effective recovery after sport such as cool downs, stretching, hydration and nutrition, and most importantly, adequate rest.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.