25 Oct Runners’ Knee
Patellofemoral pain syndrome, aka ‘runners’ knee’ or PFPS.
Most commonly found as kneecap pain.
PFPS is, in its most basic sense, a discomfort around or under the kneecap. The area effected can be anywhere in a circular perimeter around the kneecap including the areas of the patellar and quad tendons and the fat pads on either side below the kneecap.
Knee discomfort, ranging from a deep ache to a sharp pain that makes bending the knee while weight bearing difficult.
Pain with stairs (generally down being more painful than up but not always)
Discomfort, stiffness or and difficulty straightening the knee, especially after sitting or not moving more extended periods
Pain with loading activities (running, walking, squats, lunges), especially when the knee goes over the toes.
The skinny: a syndrome is usually used to describe a problem whereby multiple things can be happening. In this case, it refers to the fact that PFPS can occur from multiple sources and in multiple areas.
Tightness of the Iliotibial band, rectus femoris (one of the quadriceps) and/or the other 3 of the quadriceps…creating too much tension or pressure on the kneecap which in turn causes abrasion to the joint surface
Poor tracking of the kneecap within the groove of the femur as it slides up and down during knee bending, also causing abrasion to the knee surfaces.
Inflammation arises from both.
The former is the most common cause of PFPS seen anectodally in runners and in my practice.
The latter generally causes more wear and tear (arthritis) under the kneecap surface.
The good news: this cartilage on the underside of the kneecap is the fastest regenerating of anywhere in the body. It’s as if it was made to be worn quicker…and in fact it is. Our daily life whether stairs or running puts extra pressure on this area, so it’s crucial it can stand up to the west.
The nitty gritty:
Treating PFPS starts by figuring out the offending characters (above) and treating them
First, control the inflammation. This is done by relative rest. Avoid painful positions or exercises. Pissing off the area will just lead to further inflammation. If this is not enough, anti-inflammatories and ice can be used to hurry up the process.
Stretch the three offenders: IT Band, rectus femoris, and quads in general. Gently, several times a day in small increments. 5 minutes here and there is better than 30 min a day. Better yet, have a therapist release all of the above and continue the soft tissue and stretching work into the surrounding tissues which generally have built some scar tissue and trigger points.
Help the kneecap track smoother: Certain exercises are of some benefit here but under a therapist direction as some can cause more harm than good. Although you can’t effect tracking direction a lot, you can make minor changes to relieve some pressure. The bigger picture is making the tracking smoother, not actually a better trajectory. A smooth track will help the cartilage from getting so much abrasion (arthritis).
Sometimes we can tape the kneecap to help it track better. However, it’s not much of a practical or long term solution.
Patellar bands (Cho-pat) may also be of help during symptoms, because they help lessen the force of the lever arm of the patellar tendon.
In my practice I tend to use taping and the band as a diagnostic measure, to see how much tension we are dealing with and which of the 2 main culprits are responsible for the pain. This way I can zero in better on treatment. If the client is training for a race I often use these to help them continue without losing momentum and days off if it relieves symptoms.
Hip, glute and knee stability have also been shown to improve outcomes, but they don’t necessarily help the pain, just the relative strength/stability of the leg going forward in recovery.
For runners, there may be an extra step. Treating the cause of the tightness and pressure and wear and tear can also be having to change or learn how to run efficiently.
Seeing a running coach and learning how to run correctly, including working on your cadence for a better landing, is paramount.
PFPS is very highly associated with poor biomechanics of loading in the landing phase so the correct biomechanics and the correct running shoe should be your first two stops when you are ready to get back to running.