Patellofemoral Pain Syndrome (runner’s knee) is pain under the knee cap or anterior knee pain. It is an extremely common reason why active people (in particularly runners) seek healthcare. It occurs when the patella (knee cap) does not track properly within the patella groove. Due to excessive lateral forces on the patella it tracks laterally; therefore pain is provoked due to irritation of the free bone nerve endings.

  • Pain is provoked during loaded knee flexion (deeper = more painful). It is commonly experienced whilst walking DOWN STAIRS (or other eccentric knee extension activities).

74% of people with this problem will decrease their overall physical activity levels for at least 5 years after their initial presentation (Teyhen, 2012). THIS NEEDS TO CHANGE. Patellofemoral pain syndrome is a niggling, persistent pain which will NOT go away unless treatment is commenced!

Assessment

A holistic assessment is required when evaluating patients with runner’s knee due to its several different potential causes. These causes can originate from the hip, knee, ankle and foot!

Hip

  • Weak hip muscles lead to internal rotation of the thigh (knees falling inward, toes pointing inward) which increases the pressure experienced under your kneecap.

Knee

  • Poor medial quadriceps strength (VMO) leads to maltracking of the patella, causing it to track laterally (towards the outside of the body).
  • Pain is experienced as the patella doesn’t track smoothly within its groove, increasing the pressure experienced beneath the knee cap.

Foot & Ankle

  • Limited movement at your ankle or excessive foot mechanics can contribute to your knee pain.
  • Poor medial longitudinal arch of your foot or abnormal wear/poor support in your shoes can increase the force through your shank (shin bone). This leads to increased force through your knee (Riskowski et al., 2013).

Active Treatment

There are many potentially effective treatments available for Patellofemoral Pain Syndrome (runner’s knee).

  1. Relative Rest: if you are a novice (or experienced) runner you MUST understand the importance of rest. If you have poor running technique and this is aggravating your symptoms, then rest is INTEGRAL in treating your runner’s knee.This allows your muscles to recover, to avoid further inflammation or irritation within the joint itself. Reduce the TIME spend running and the FREQUENCY for a few weeks, to allow symptoms to settle.
  2. Strengthening: Exercises to strengthen the hip (gluts) and knee (quads) muscles will reduce the force and pressure underneath your knee cap. This occurs as the joints above and below the knee are more efficient in their action. Thus, improving their force absorption, reducing pressure in the knee itself! An inner range quads strengthening program targeting the vastus medialis obliqus (VMO) aids in providing a medial force to your knee cap. Thus, reversing the pain experienced from to the overpowering lateral quads muscles pulling the patella laterally.
  3. Running Training: this consists of a program focusing on pelvic control, knee control and ankle control. It is a great way to improve your running technique – reducing and preventing the aggravating impact it may have on your condition. It will aim to teach techniques to stabilise your pelvis/hip as you run as well as avoiding inward knee collapse.

Alternate Treatments

  1. Taping: a simple, effective way of mechanically keeping your patella tracking within the patella groove. The tape provides a medial force on your knee cap forcing it inwards, therefore reversing the lateral (outward) force during walking, running, stairs etc.
  2. Orthotic Devices: this provides more support into the medial longitudinal arch of your foot. Evidence shows that individuals with a planus (collapsed arch) foot posture are more likely to have knee pain. This is because they reduce laterally-directed soft tissue forces from the patellar tendon, the quads tendon and the ITB as well as reduce Q-angle (reduce degree of inward collapse).

Summary

  • Treatment is essential for Patellofemoral Pain Syndrome as symptoms will NOT improve on their own!
  • It is caused by the lateral maltracking of the knee cap within its groove during walking, running or stairs.
  • Strengthening will provide increased stability at the hip, knee and ankle – thus reducing the lateral forces on the knee cap!
  • Further therapy options have been proven to be effective in mechanically reducing the pressure experienced under the knee cap.