Since many of our clients and friends are running in the NYC marathon this weekend we thought we would talk about patellofemoral knee pain.
One of the more common running injuries we see here in the office is patellofemoral pain syndrome (PFPS), known colloquially as runner’s knee or kneecap tracking problems, and is characterized by pain toward the front of the knee, commonly either behind or to one side of the kneecap, and made worse by impact loading activities (running, jumping), walking downstairs and maintaining the knee in a bent position (ie. sitting). In this final example, the sufferer will commonly find relief by extending the knee, prompting them to take a seat next to an aisle at a theater or sporting event. In the physio world we call this the ‘movie-goer’s sign!’
Many runner’s may be aware that strength of the inside quad muscle, the Vastus medialis obliquus, or VMO (see illustration right), an important stabilizer of the patella, and tightness in the Ilio-tibial band (ITB), the sinew that runs the length of the outside of the thigh, have something to do with PFPS, and they’d be right, but that is only half the picture.
Research in the first decade of the 21st century has come to confirm what many physical therapists already suspected; that the missing link in the management of PFPS was actually what was going on at the hip, and to a lesser extent, the foot. It was demonstrated that weakness or a loss of control in certain, specialized muscles of the hip led to a change in how forces were transmitted across the knee when a patient exercised or compressed their kneecap, and that THIS subsequently led to ITB tightness & VMO weakness.
This evidence was strong enough that the detection of hip weakness in a population of athletes could actually predict who would develop PFPS & who wouldn’t.
Physical therapists, as movement analysis and exercise prescription experts, are ideally placed to screen, detect and treat these biomechanical shortcomings, using a combination of skilled manual therapy and specific therapeutic exercise. Patellar taping can also be used and is an effective adjunct to management. In addition, flaws in training methods and/or running biomechanics can be identified and corrected to avoid overload situations that may precipitate onset.
The literature shows that this form of treatment is effective, and patients rarely require injection or surgical intervention. Rest on its own is not a cure, and there is evidence to suggest that if left untreated, PFPS can go on to become premature onset osteoarthritis of the kneecap.
So get out there and get running, but build things up steadily. And if you develop pain around your kneecap, know that the physical therapists at KIMA will have you back on track painfree by managing not just your symptoms but the underlying causes!