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Sports injuries – Runner’s knee and how to address it

Runner’s knee – how to deal with patellofemoral pain syndrome

Rosemary Marchese – Physiotherapist

Sore knees are one of the most common complaints amongst athletes, even children.  It’s also common in older people, particularly as osteoarthritic changes set in. Patellofemoral pain syndrome is the medical term for the pain felt behind the knee cap (patella). The patella sits in a groove in the thigh bone (femur) and it needs to be able to glide nicely in this groove. When things happen that don’t allow this movement you often end up with pain. Sometimes there can even be a subluxation (where the knee cap partially comes out of place) and that can be very painful.

Anatomy of the knee

Why does knee pain happen?

Generally something is going wrong around the hips, knees or ankles, and sometimes even up higher, that causes malalignment of the patella. When this occurs pain starts, often intermittently. The problem with pain is that it causes us to change the way we do things, which sometimes can make it even worse. Pain also causes muscle inhibition, so the muscles around the knee cap start to do a less optimal job, causing further pain. At first you may feel a little niggle, say as you walk down stairs, but eventually it becomes more frequent, more intense and more activities start to hurt. This pain cycle is the first thing I like to address so a patient can get out and about with less pain and the body can start to do its job properly again.

What are some causes?

The answer is often different from patient to patient. Trying to find the cause of the problem is my job, and one of the first things I aim for is a reduction of pain.  Potential causes of the problem include one or more of the following factors:

  • arthritis, which changes the smoothness of bones and hence makes for a less optimal glide between bones
  • poor quality shoes
  • poor foot biomechanics and structure
  • poor postural habits that affect your entire alignment
  • one or both hips that internally rotate and cause the knee cap to not sit in an optimal position
  • poor muscle activation of particular muscles, such as the quadriceps, gluteals and calf
  • poor flexibility in particular parts of the body
  • running technique
  • injury to other structures that then affect walking and running
  • swelling from other injuries around the knee
  • sudden increases or changes to training volume, duration, type or intensity

This type of pain is quite common amongst particular sports, such as running, netball and basketball where there are frequent high loads on the knee joint.

What to do about it

I can’t stress enough how important it is to address the pain. You may have to cut back what you are doing temporarily while you get to the cause of the problem. Sometimes this can mean some simple changes to your techniques in training or even how you do things in your day-to-day life. For example if you have poor knee control from weak gluteals then you will likely be exacerbating the problem every time you walk up stairs or for a run. Learning how to use these muscles better can help with this situation.

A physiotherapist can:

  • confirm the diagnosis and make sure there is no other knee problem as well
  • tell you who to see or what to do if the situation requires further intervention
  • identify the cause/s
  • provide pain relief measures such as taping, manual therapy, posture correction and exercises
  • address tightness and weakness and provide a progressive plan to help you get back on track