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WHAT IS RUNNER'S KNEE?

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Patellofemoral pain syndrome is a broad term used to describe pain in the front of the knee and around the patella, or kneecap. It is sometimes called "runner's knee" or "jumper's knee" because it is common in people who participate in sports, but patellofemoral pain syndrome can occur in non-athletes, as well. The pain and stiffness it causes can make it difficult to climb stairs, kneel down, and perform other everyday activities. 

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Patellofemoral pain syndrome occurs when nerves sense pain in the soft tissues and bone around the kneecap. These soft tissues include the tendons, the fat pad beneath the patella, and the synovial tissue that lines the knee joint.

In some cases of patellofemoral pain, a condition called chondromalacia patella is present. Chondromalacia patella is the softening and breakdown of the articular cartilage on the underside of the kneecap. There are no nerves in articular cartilage—so damage to the cartilage itself cannot directly cause pain. It can, however, lead to inflammation of the synovium and pain in the underlying bone.

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SYMPTOMS

The most common symptom of patellofemoral pain syndrome is a dull, aching pain in the front of the knee. This pain—which usually begins gradually and is frequently activity-related—may be present in one or both knees. Other common symptoms include:

  • Pain during exercise and activities that repeatedly bend the knee, such as climbing stairs, running, jumping, or squatting.

  • Pain after sitting for a long period of time with your knees bent, such as one does in a movie theater or when riding on an airplane.

  • Pain related to a change in activity level or intensity, playing surface, or equipment.

  • Popping or crackling sounds in your knee when climbing stairs or when standing up after prolonged sitting.

CAUSES

OVERUSE

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In many cases, patellofemoral pain syndrome is caused by vigorous physical activities that put repeated stress on the knee —such as jogging, squatting, and climbing stairs. It can also be caused by a sudden change in physical activity. This change can be in the frequency of activity—such as increasing the number of days you exercise each week. It can also be in the duration or intensity of activity—such as running longer distances.

Other factors that may contribute to patellofemoral pain include:

  • Use of improper sports training techniques or equipment

  • Changes in footwear or playing surface

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PATELLAR MALALIGNMENT

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Patellofemoral pain syndrome can also be caused by abnormal tracking of the kneecap in the trochlear groove. In this condition, the patella is pushed out to one side of the groove when the knee is bent. This abnormality may cause increased pressure between the back of the patella and the trochlea, irritating soft tissues.

Factors that contribute to poor tracking of the kneecap include:

  • Problems with the alignment of the legs between the hips and the ankles. Problems in alignment may result in a kneecap that shifts too far toward the outside or inside of the leg, or one that rides too high in the trochlear groove—a condition called patella alta.

  • Muscular imbalances or weaknesses, especially in the quadriceps muscles at the front of the thigh. When the knee bends and straightens, the quadriceps muscles and quadriceps tendon help to keep the kneecap within the trochlear groove. Weak or imbalanced quadriceps can cause poor tracking of the kneecap within the groove.

TREATMENT

STRETCH

Stretching can help release muscles that may be pulling the patella out of alignment. Perform the following stretches to help reduce Patellofemoral pain.

KNEELING HIP FLEXOR STRETCH

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The Kneeling Hip Flexor Stretch can be done anywhere — at home or the office, or at the gym before working out. Oftentimes a yoga mat or towel on the ground will help keep the knee comfortable as you kneel. Here is how you do it:

 

  1. Get in a kneeling lunge position with one knee on the floor and the other leg bent 90 degrees in front of you with foot flat. Place one hand on your hip. This is your starting position.​​

  2. Squeezing your back glutes, shift your body weight slightly forward while maintaining an upright torso. Reach around to grasp your foot with your free hand to increase the stretch. Hold for 30 - 60 seconds.

STANDING QUAD STRETCH

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What's so great about the standing quad stretch? You can do it anywhere! The standing quad stretch can be done in the office, at the gym, or outside just before a long run. If you can find a place to stand, you can do the standing quad stretch. Here is how you do it:

  1. While standing, hold onto a countertop or chair back to assist in balance.

  2. Bend your knee back by grasping your ankle with one hand.

  3. Assist in bending your knee back as far as possible.

  4. Maintain position for 30 seconds.

  5. Return to standing position.

  6. Repeat exercise 3 to 5 times with each leg.

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Be sure to stop the stretch if you feel any sharp pains. See your physical therapist to be sure you are performing the stretch properly.

LYING CROSS-OVER  HIP STRETCH

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The Lying cross-over hip stretch is a good one because it can be done anywhere — at home or the office, or at the gym before working out. Here is how you do it:

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  1. Lay on your back.

  2. Bring your knee up toward your chest.

  3. With the opposite hand, grab just above the knee and pull your leg across your body.

  4. Ensure that shoulders remain in contact with the ground.

  5. Hold for 30 seconds.

  6. Slowly return to the original position

  7. Repeat on the opposite side.

 

Some people feel a stretch in the area of their hip where the ITB arises, while others feel a tightness at their knee during this stretch.

STRENGTHEN​

The next important phase in the physical treatment of Runner's Knee is to perform exercises to strengthen the muscles in the affected area. Stabilizing the hips, glutes and balancing out the thigh muscles will help keep your knee in proper alignment and reduce injury risk.

SIDE LEG LIFT

BACK BRIDGE

HIP AND GLUTE STABILITY

*Always consult with your medical professional. We do not claim to be medical professionals, these are observations of things that we have seen to work in our own experience. These are here for your own personal knowledge and study not for any medical diagnosis. 

REFERENCE:

Patellofemoral Pain Syndrome. (n.d.). In Orthoinfo. Retrieved February 17, 2020 from https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/

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Patellofemoral Pain: 2018 Consensus statement on exercise therapy and physical interventions (n.d). In Physiopedia. Retrieved from https://www.physiospot.com/research/patellofemoral-pain-2018-consensus-statement-on-exercise-therapy-and-physical-interventionsns/

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Crevling, M. (2018, October 12). What's the Best Solution for Runner's Knee?. Retrieved from https://www.runnersworld.com/health-injuries/a20854077/whats-the-best-solution-for-runners-knee/

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