Runner’s Knee

Also know as Patellofemoral Pain Syndrome

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.

Many things may contribute to the development of patellofemoral pain syndrome. Problems with the alignment of the kneecap and overuse from vigorous athletics or training are often significant factors.

Symptoms are often relieved with conservative treatment, such as changes in activity levels, footwear, orthotics or a therapeutic exercise program.

Causes
Overuse

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

Patellar Malalignment

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.
  • 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.

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 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.

Home Remedies

In many cases, patellofemoral pain will improve with simple home treatment.
Stop doing the activities that make your knee hurt until your pain is resolved. This may mean changing your training routine or switching to low-impact activities that will place less stress on your knee joint. Biking and swimming are good low-impact options. If you are overweight, losing weight will also help to reduce pressure on your knee.

Rice

  • Rest. Avoid putting weight on the painful knee.
  • Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly on skin.
  • Compression. To prevent additional swelling, lightly wrap the knee in an elastic bandage, leaving a hole in the area of the kneecap. Make sure that the bandage fits snugly and does not cause additional pain.
  • Elevation. As often as possible, rest with your knee raised up higher than your heart.

Clinical Examination

To help diagnose the cause of your pain and to rule out any other physical problems, your podiatrist may also check:

  • Alignment of the lower leg and the position of the kneecap.
  • Knee stability, hip rotation, and range of motion of knees and hips.
  • The kneecap for signs of tenderness.
  • The attachment of thigh muscles to the kneecap.
  • Strength, flexibility, firmness, and tone of the hips, front thigh muscles (quadriceps), and back thigh muscles (hamstrings)
  • Tightness of the heel cord and flexibility of the feet.

Finally, you may be asked to walk back and forth in order to examine your gait (the way you walk). Your podiatrist will look for problems with your gait that may be contributing to your knee pain.

X-Rays

X-rays could be ordered to rule out damage to the structure of the knee and to the tissues that connect to it.

Treatment

Treatment for patellofemoral pain syndrome is designed to relieve pain and restore range of motion and strength. In most cases, patellofemoral pain can be treated non surgically.

Nonsurgical Treatment

In addition to activity changes, the RICE method, and anti-inflammatory medication, your doctor may recommend the following:

  • Shoe inserts (custom orthotics) take stress off your lower leg by aligning your foot and ankle.
  • Physical therapy exercises. Specific exercises will help you improve range of motion, strength, and endurance. It is especially important to focus on strengthening and stretching your quadriceps since these muscles are the main stabilisers of your kneecap.

Prevention

Patellofemoral pain syndrome is usually fully relieved with simple measures and or physical therapy. It may recur, however, if you do not make adjustments to your training routine or activity level. It is essential to maintain appropriate conditioning of the muscles around the knee, particularly the quadriceps and the hamstrings.

Come in and see how our podiatrists can get you running pain free.
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