Runners Knee Physiotherapy

Physiotherapy treatment for Runners Knee injuries

Runner's Knee

Runner's Knee is a condition that causes knee pain originating from the joint between the knee-cap (patella) and thigh bone (femur), which is called the patellofemoral joint. The knee pain is usually associated with inflammation or damage to the patellofemoral joint.

Runner's Knee is also known as Patellofemoral Pain Syndrome, PFPS, Patellofemoral Syndrome, Patellofemoral Joint Syndrome, PFJ Syndrome, Chondromalacia Patellae, Anterior Knee Pain, and Mechanical Knee Pain.

The knee-cap or patella is situated at the front of the knee and lies within the quadriceps tendon which attaches to the top of the tibia, one of the shin bones. The knee-cap is triangular in shape and sits in the v shaped groove at the front of the femur forming the patellofemoral joint. Cartilage lines the bones which allows cushioning and reduces friction. The quadriceps muscles at the front of the thigh straighten or extend the knee from a bent position, and form the extensor mechanism of the knee joint. Normally, the action of the quadriceps muscles pulls the patella evenly in its groove with the femur, and the knee joint is aligned correctly.

In patients with Patellofemoral Pain Syndrome the patella is usually malaligned and doesn't track smoothly in its groove relative to the femur, this places more stress through the patellofemoral joint and results in pain and inflammation, presenting under or around the knee-cap. There are various reasons why this malalignment or poor tracking of the patella occurs. Commonly it is an imbalance in the strength of the quadriceps muscles, and usually the outer lateral quadriceps the vastus lateralis is stronger than the inner quadriceps the vastus medialis or the VMO, resulting in the patella being pulled sideways towards the outside of the leg.

Patellofemoral pain syndrome is very common in runners, hence the lay-person name of Runner's Knee. There are several predetermined anatomical factors that can predispose a person to Patellofemoral pain syndrome, including the natural position and shape of your feet, and an increased Q angle, this is the angle formed between the pelvis and the patella and the patella to top of the tibia.

Typically with Runner's Knee even after taking a few days off running or sport and resting, the pain behind or around the sides of the knee-cap can come right back. This is because although the inflammation has decreased, the cause of the pain still exists and hasn't changed. Additionally, the pain often feels worst when running or walking downhill or down stairs and the knee is often stiff and sore after sitting down for long periods. You might hear or feel a crunching or clicking sound when you bend or extend your knee.

Most cases of Patellofemoral pain syndrome settle well with an appropriate physiotherapy program. This is an easily treatable injury if you have a little patience. Careful assessment by a qualified physiotherapist can determine the causative factors, and therefore the subsequent correction of these factors can help to stop the pain reoccurring.

Ice and anti-inflammatories can help to speed up the recovery, along with tailored exercises and stretches from your physiotherapist. If, in combination with specific quadriceps strengthening exercises, the lower leg biomechanics cannot be changed enough to get rid of the injury, a podiatrist may be recommended for orthotics. The success rate of getting rid of this injury is largely dictated by patient compliance and their dedication to the prescribed exercises. Rest is a key component of treatment, and activities which place large amounts of stress through the patellofemoral joint should be limited.

Ignoring symptoms or having a 'no pain, no gain' attitude is likely to lead to the injury becoming worse and even chronic. Immediate, appropriate treatment in all patients with Runner's Knee of Patellofemoral syndrome will ensure a good recovery. If the condition becomes chronic, healing slows significantly and there is an increased likelihood of future recurrence.