Runners Knee

Knee pain is a common complaint we see at City Physio. Patellofemoral pain syndrome (PFPS), also known as “Runners Knee” is one such condition that we regularly see and can affect, both runners and non-athletes!

The Knee

The knee is a complex joint comprised of 4 bones, the patella (knee cap), femur (thigh bone), tibia and fibula (2 shin bones). Holding these bones together are ligaments, tendons and muscles that contribute to joint stability and movement. The patella rests in the trochlear groove of the femur and is anchored above and below by tendons. The articulating surfaces between the patella and the femur are termed the patellofemoral joint.

What is Patellofemoral pain syndrome/ Runners knee?

PFPS, or runner’s knee, is a non-specific diagnosis used to describe pain at the front of the knee, behind the patella. People often complain of pain which is aggravated by activities such as running, stair climbing – more frequently downstairs, squatting and kneeling which gradually worsens over
time. PFPS is due to excessive pressure in the patellofemoral joint and often caused by poor knee alignment or mal tracking of the patella. The good news is that runner’s knee alone isn’t a structural problem, i.e. ligaments and cartilage are not damaged, however pain is the result of a poor loading strategy secondary to a sub- optimal movement pattern.

The patella and the femoral groove should function like a train on the track- when the train deviates from the track we run into a few problems. This abnormality is sometimes called patella maltracking.
An increase in compressive force can create symptoms like pain, grinding and/ or clicking. If this loading irregularity persists a localised inflammatory response may develop starting to cause pain even when at rest.

PFPS is commonly caused by changes in force at the knee due to altered biomechanics. A few reasons for such changes occuring are changes to daily behaviours and postures, previous injury in the lower limb or back, or rapid changes in exercise loads which create muscle fatigue and tightness.
The above contributors aren’t necessarily local (knee) problems however cause changes to function in the system which may create compensations that alter angles at the knee joint when loading. There may also be an anatomical predisposition to runner’s knee- the Q angle or angle between the hip, knee and foot is exaggerated in those with a wide pelvis (more typically women) and those with flat feet and increased pronation.

External factors such as poor load management, training errors and inappropriate footwear can also
contribute to PFPS.

What can we do about it?

Taking a comprehensive history and physical assessment to rule out any nasties is a rule of thumb! After confirming the diagnosis, a game plan revolving short, mid and long term goals is formulated. Rehabilitation is variable from person to person depending on what groups of muscles are tight o weak. As touched on above, part of the plan often involves restoring stability higher or lower in the chain, i.e. hip and or ankle/ foot, while concurrently optimising strength of the muscles that produce and absorb force at the knee, i.e. the quadriceps, hamstring, and gastrocnemius. Sports taping or bracing is often utilised short- term to unload the joint and allow for symptomatic improvement and a quicker return to training or sport.
If your knee pain is persistent, don’t wait! Pop in now to see one of the physios at City Physio for an in- depth assessment and management plan to allow you to participate and perform at your peak!

Patellofemoral pain using K tape

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