Patellofemoral pain (runners knee) is an insidious injury that kind of creeps up on you. It affects both athletes and non athletes alike. It typically presents as pain in or under the knee cap. This makes it very frustrating as you can’t quiet put your finger on it. The cause of patellofemoral pain (PFP) is likely multi factorial, with different factors contributing to varying degrees in each individuals pain. Uncovering which factors contribute to the pain presentation is challenging.
Potential Pain Sources
The synovium, bursea, plica, lateral retinaclumn, fat pads etc are a number of soft tissue structures that have a pain producing potential in the knee. All these potential sources of pain muddy the water a bit. However finding which is producing the pain may not be so important. What’s more pertinent is which factors are contributing to the pain.
Typically, going up but especially coming down stairs or downhill will evoke pain. A prolonged sitting position with knee bent (long drives or sitting at the cinema) will also produce pain. The knee may feel stiff and a bit puffy. Any giving away is probably due to muscle inhibition from the pain. You may or may not hear noises (crepitus) in the knee. Anything else that loads the knee (squats, lunges, leg press, etc) will also result in pain.
Possible Causes of Patella Femoral Pain Syndrome
- Increased Q angle
- Dynamic knee valgus
- Foot over pronation
- Weak hip musculature
- Altered firing patterns in vastus medialis and vastus lateralis
- Weak Quadricep musculature
- Femoral internal rotation
- ITB, gastrocnemius, quads, hamstring tightness.
- Patellar medio lateral glide/tilting
- Training errors
Physical Therapy Treatment
How we move affects how much load is placed on our knees. The shape of our bones and strength of our (hip) muscles have an impact on the load placed on the knee. Research shows that a targeted strength programme tailored to meet the patients clinical findings in combination with “off the shelf” foot orthotics is best practice. Other modalities such as taping and manual therapy can have a positive effect on pain and function when used with a targeted strengthening programme. Most suffers start to feel relief from 6-12 weeks after starting a rehabilitation programme.
Other modalities such as ice, ultrasound, electrical stimulation, EMG biofeedback and laser do not reduce pain and function in patellofemoral pain. Reference.