PATELLOFEMORAL PAIN SYNDROME (RUNNER'S KNEE) - CAUSES AND TREATMENT

​Do you have pain around your knee cap when squatting or descending stairs? Does it get worse after prolonged sitting? In case you have any of these symptoms, chances are that you might have patellofemoral pain syndrome (PFPS), also called the runner’s knee.

Do you have pain around your knee cap when squatting or descending stairs? Does it get worse after prolonged sitting? In case you have any of these symptoms, chances are that you might have patellofemoral pain syndrome (PFPS), also called the runner’s knee.

Runner’s knee got its name for an obvious reason – it is highly prevalent among runners. But why is this the case? Running represents a cyclical activity, which means that phases of the running movement repeat over and over again. In case you have even a small movement flaw, that flaw can become a big issue down the road if you run with enough intensity and duration. Specifically to the runner’s knee, there are certain biomechanical and structural factors that indicate a higher risk for this condition which will be described later in this article.


WHAT IS PFPS AND WHAT CAUSES THIS CONDITION? 
Runner’s knee is the most common of all running injuries and can account for up to 16% of all running injuries. Common symptoms include dull ache behind and around the kneecap, that usually gets worse after sitting. In addition to squatting and descending downstairs, you will have issues running downhill, as well as resisting leg extension (i.e. straightening the knee joint). As you warm up you might feel ache subsiding, only to return after cessation. 

The exact cause of runner’s knee is difficult to pinpoint. However, we know that there are certain factors that increase the likelihood of someone developing PFPS:

• Doing too much, too soon – abrupt increase in volume and/or intensity so that body cannot handle this extra load;
• Quadriceps and especially hip musculature weakness.
• Poor neuromuscular coordination – individuals with PFPS often display poor single leg balance and poor vertical jumping ability;
• Reduced flexibility – iliotibial band, quadriceps, hamstrings and calf musculature stiffness, all play a role in PFPS;
• Running form – foot overpronation and hip adduction have been implicated in development of PFPS. Overstriding when running may be another thing to look at, since this might produce high forces and sensitize tissues around the knee cap.
• Women are more susceptible compared to men. This is partly explained by wider pelvis in women, which indirectly affects knee mechanics. Another explanation is that women have lower hip strength, which forces thigh bone into adduction and subsequently causing knee collapse and abnormal kneecap tracking and pain;

PATELLOFEMORAL PAIN SYNDROME FIX
Based on the previous section, it becomes clear what steps need to be taken in order to get rid of PFPS – muscle strengthening, flexibility training, running form correction and neuromuscular control training. To get you started here are some exercises that you can use right away to get you back on the road of recovery:

1.Band Clamshell

​2. Isometric Quad Strengthening

​3. Side Step Band

​​4. Single-Leg Deadlift

​5. Standing glute med

​Depending on the severity of your symptoms, you might only need a week or two off, but if you are having this issue for a while now, then it might take up to 4-6 weeks or more until you can get back to running pain –free.

TAKEAWAY
First step when dealing with PFPS is to reduce load on your knee joint and let the inflammation calm down. During this time it is prudent to focus on progressive strengthening of the knee and hip muscles, that will help to support your knee joint.  In addition to strengthening, flexibility work for particular muscle groups will aid in the recovery as well.  And lastly, pay attention to your running form and make sure that you are not putting excessive strain on your knee joint by overstriding, having excessive foot pronation and knee collapse.