Patello-Femoral Pain (Runner's Knee)

Patelleo-Femoral Pain Syndrome / Runner's Knee Treatment in Adelaide

What is Patellofemoral Pain (PFP)?

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Patellofemoral pain (PFP) is a common condition where pain is felt on the front of the knee, either around or behind the patella.

It occurs in up to 20% of the population (1).

The patellofemoral joint is part of the knee joint, where the kneecap (patella) sits within its groove (trochlea) on the front of the thigh bone (femur).

A smooth layer of joint cartilage covers the trochlea and the back of the patella to help the joint surfaces glide without friction.

There are several muscles and ligaments that help hold the patella centred on the trochlea. 

The patellofemoral joint functions as a pulley system to help the quadriceps muscles straighten the knee most efficiently.

Pain often results when there is excessive compression on the patella or a muscle imbalance around the patella causes mal-tracking of the patella.

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What are the most common symptoms of PFP?

  • general ache/pain in the front of the knee
  • pain aggravated activity involving a bent knee and body weight on the leg (e.g. walking up and down stairs, squatting, kneeling, jumping or hopping)
  • pain aggravated by sitting for prolonged periods e.g. driving or sitting in a movie theatre (eg, jumping, hopping, running, going up or down stairs, or squatting).
  • some people also hear and feel a grinding / clicking around the knee with mild swelling

An x-ray or MRI is not usually necessary to diagnose PFP.

Patello-femoral pain is often mis-diagnosed as knee osteo-arthritis in young people, due to the deep ache that is often felt.  An assessment by a Physiotherapist will help to clarify your diagnosis.

Who is most likely to be affected by PFP?

The main risk factor for developing PFP is recent spike in training load. 

PFP is common in:

  • runners
  • cyclists
  • triathletes
  • cross fitters
  • football, basketball, jumping sports
  • hikers (especially going downhill)

Biomechanical issues that can predispose to PFP include:

  • weakness in glutes, quads (VMO), core, calves
  • tight ITB, TFL, quads (outer), hamstrings, calves
  • stiffness in ankles (e.g. post ankle sprain)
  • stiffness in the hip joints / hip flexors
  • runners with who predominantly heel strike

 White et al (2009) showed that patients with patellofemoral pain had shorter hamstring muscles than asymptomatic controls.

Anatomical factors include:

  • kneecap that sits too high or wide (laterally) in its groove
  • trochlea groove that is relatively shallow
  • variations of the shape of the hip and thigh bone that cause the knee to turn inwards with walking
  • foot posture (eg, flat feet)

What is the most effective treatment?

There is strong evidence to support a tailored physiotherapy (including exercise, education, taping), compared to placebo in the short (six weeks) and long-term (one year).

Evidence shows a personalised exercise program (combination of stretching and strengthening) gives the best long term outcomes. 

Ideally this exercise program is set up by a Physiotherapist after a comprehensive assessment. 

How long until I feel better?

As our understanding has grown, it has become clear that PFP is not necessarily something that will disappear on its own, and some people can have episodes on and off for many years.

As such, in order to have the best chance of recovering from your PFP and reducing the likelihood of it recurring, it is important to understand your condition, your individual contributing factors and what you can do.

For many people, a program of ongoing and progressive exercise (as prescribed by your physiotherapist) is necessary to build and maintain muscle strength, and good movement coordination.

Additionally, there is evidence suggesting that people with PFP may have an increased risk of going on to develop patellofemoral osteoarthritis (OA). Therefore, seeing an experienced physiotherapist for a management program will help you keep your patellofemoral joints functioning as well as possible, and keep you as active as you’d like to be now and into the future.

What can I do?

  • avoid aggravating activities
  • ice your knee
  • home exercises

For Runners:

  • avoid hills
  • cut back on your running mileage
  • increase your cadence by 5-10%
  • check your shoes - time for a new pair?
  • focus on cross training - swimming, pilates, yoga e.t.c.

Some of the common foam roller exercises we prescribe:

Calf

Calf

Hamstring

Hamstring

ITB

ITB

Quads

Quads

How can a Physiotherapist assist with recovery?

1.  Assessment and Diagnosis

A modest investment in a Physio Assessment early on  in your journey pays big dividends in terms of identifying relevant contributing factors and helping you get on the fast track to healing. 

We spend a lot of time in the beginning educating you so you know what to expect in terms of recovery and what you need to do, to manage your recovery successfully.

"Give me six hours to chop down a tree and I will spend the first four sharpening the axe." - Abraham Lincoln

2.  Dry Needling / Massage and Taping

Often 3-5 sessions of manual therapy will help re-set your tissues and get you into a position where you can confidently self-manage. 

Muscles that are commonly tight and affecting your knee include the

  • ITB
  • TFL
  • hamstrings,
  • quads and calves

Foam rolling and spiky ball massage are effective at maintaining flexibility, but dry needling has the ability to get to the deeper part of the muscle and get a more effective release. 

Find out more about dry needling here.

We can also show you how to tape your knee to provide relief in the short-term.

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3.  Guidance on load management

We will give you advice on how to gradually re-load your tissues to safely protect your knee from future flare-ups.  We work with your coach or trainer to manage your return to doing what you love. 

4.  Building a personalised home exercise program

You are the most important part of the healing process and what you do is the most important part getting you better. 

We use the convenient Physitrack App to build your personalised home program with videos delivered to your smart phone.

5.  Movement Re-Training

Once your pain is under control we then watch how you move and optimise your movement patterning to decrease the chances of the knee pain returning.

Pilates can be a very effective way to maintain efficient movement patterns.

Is Knee Pain or Injury keeping you from being as active and healthy as you want?

References:

1.  Boling M, Padua D, Marshall S, et al. Gender differ- ences in the incidence and prevalence of patellofe- moral pain syndrome. Scand J Med Sci Sports 2010;20(5):725–30.

2. 

Wood L, Muller S, Peat G. The epidemiology of patellofemoral disorders in adulthood: A review of routine general practice morbidity recording. Prim Health Care Res Dev 2011;12(2):157–64.

 


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Dan O'Grady is a results driven qualified Physiotherapist and member of the Australian Physiotherapy Association.  Dan has a special interest in treating knee pain.  He has been working in private practice for 15 years with (over 20,000 patient consults). He is passionate about helping people to move better, feel better and get back to doing what they love.

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