One of the most common reasons to visit a physiotherapy clinic is front (anterior) knee pain. This is particularly true for distance runners and other endurance athletes. This type of pain usually presents anywhere along the front of the knee and can often shift around the knee cap (patella). So while it may be hard to localize the site of pain, this non-specific pain can often be an important clue to diagnosis by your physiotherapist or sport medicine doctor. It can sometimes be referred to as chondromalacia patellae, anterior knee pain or the preferred term, patellofemoral pain syndrome (PFPS).
Relevant Anatomy
The patellofemoral joint (PFJ) is just the knee cap on the femur (thigh) bone. The knee cap slides along a groove on the femur as the knees bends and straightens. The knee cap lies within the quadriceps tendon which is one structure that holds it in place along with ligaments. Excessive pressure or tension through the quadriceps can place more stress on this joint and potentially irritate it.
What tends to aggravate Runner's Knee?
There are many factors that can contribute to PFPS all with varying degrees depending on individual anatomy. Extrinsic factors are the easiest to spot and adjust and these include:
Increased or unaccustomed load i.e. more running distance or new to running
Higher loads i.e. increased body mass or larger forces like jumping
More loading cycles or frequency i.e. speed and how quick your strides are
There are other factors that can play a role that are intrinsic to each individual and how load is distributed through the PFJ. This can be influenced by many nearby, local anatomy or further ‘remote’ factors that aren’t right by the knee joint. Examples of these are:
Alignment of the patella and how it moves or tracks
Femur and/or tibia rotation
Strength and mobility through the core and lower limb
Foot anatomy i.e. pronation / supination
What can Physio do to help?
Treatment of PFPS should address a few relevant factors to the athlete. Not one size fits all as there can be so many factors with different levels of contribution, so a ‘cookie-cutter’ approach is discouraged.
Step 1 - Address the pain
Initially pain should be reduced via modifying loads i.e. less running, different shoes or running technique. This can also be achieved via taping techniques or address the joint and muscles through IMS (intra-muscular stimulation) / dry needling or manual therapy. Some specific exercises can also help to decrease pain.
Step 2 - Address intrinsic factors
Following a reduction in acute pain, focus can be shifted to preventing it from occurring again. This might be load management where a slow build up occurs to allow the PFJ to build up its capacity. Relevant anatomy may also be addressed here such as core, hip, leg, ankle, foot strength and mobility. Exercise and movement retraining should be the core focus of any rehabilitation treatment plan. Passive strategies such as needling, massage and manual therapy shouldn’t be the main strategy beyond step 1. For an individualized rehab program, seek an assessment by a physio that understands running and strength training to get you back into running.
Image 1 and 2: https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/
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