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Causes, Symptoms, and Treatment of Runner’s Knee

With the TCS New York City Marathon fast approaching, many runners hit the streets and returned to running after several months of inactivity or indoor running. In their excitement, many of these runners didn’t progress slowly back into running, and thus became more susceptible to injuries, including patellofemoral syndrome, which is often referred to as “runner’s knee.”

Patellofemoral syndrome is one of the most common types of knee pain. It is caused by imbalances in the forces that control the tracking of your patella (kneecap) on your femur (thighbone).  Forces on the patellofemoral joint range from 1/3 to 1/2 of body weight during walking, 3 times body weight with stair climbing, 5 to 6 times body weight with running, and up to 7 times body weight with squatting.

Causes Which May Contribute to Developing Patellofemoral Syndrome:

  • Overuse

  • Flexibility deficits at the hamstring, iliotibial bands, or quadriceps

  • Weakness of hip musculature, particularly gluteus medius

  • Lower extremity malalignment

  • Excessively worn or inappropriate footwear

  • Resuming running after periods of inactivity

  • Progressing distance too quickly

  • Trauma to the knee

  • Tight lateral structures including lateral quadriceps, iliotibial band, and connective tissue called the lateral retinaculum

  • Patellar hypermobility

  • Poor quadriceps strength

Symptoms of Patellofemoral Syndrome:

  • Usually a gradual onset, but may arise following trauma

  • Stiffness or pain following prolonged sitting with the knees bent

  • Giving way of the knee

  • Pain behind or around the patella (kneecap) with activities that load the patellofemoral joint including stair climbing, squatting, running

Self-Treatment for Patellofemoral Syndrome:

  1. Relative rest is a good place to start. You should also reduce impact activities such as squats, running, and jumping.

  2. Ice. Apply ice for 10 to 20 minutes after activity is reasonable. A frozen gel pack, crushed ice in a plastic bag, or a bag of frozen vegetables work well. For added comfort, you can wrap a simple elastic band around the ice to keep it in place.

  3. Footwear plays a key role in knee pain. The quality and age of footwear are more important than the brand name. It is not uncommon to hear runners state that a new, quality shoe helped alleviate their knee pain. It is recommended that runners change their shoes every 300 to 500 miles.

  4. Arch supports or custom orthotics can be helpful in runners with a wide variety of lower extremity complaints, including patellofemoral pain. You can try over-the-counter arch supports for a relatively inexpensive initial suggestion. Custom orthotics may be worth a try if your over-the-counter insert is not helpful, although the expense is greater, and clinical results for patellofemoral pain have not been clearly established.

  5. Many runners turn to the use of knee sleeves and braces, but these devices are controversial and the use of a knee brace or sleeve should not be considered a substitute for therapeutic exercises.

Exercises and Physical Therapy for Patellofemoral Syndrome:

Physical therapy is an important component in the treatment of patellofemoral syndrome to identify underlying causes and restore function. A physical therapist will perform an evaluation, identify the specific factors causing the symptoms, and design an individualized program to address your needs.

Some common elements of treatment include:

  • Flexibility exercises for the hamstrings, quadriceps, and iliotibial bands

  • Quadriceps strengthening

  • Gluteal strengthening

  • Soft-tissue mobilization

  • Joint mobilization

  • Balance and proprioceptive (body’s awareness of where it is in space) activities

  • Retraining of lower extremity biomechanics

  • Education in a return-to-run program

If you have been experiencing symptoms of patellofemoral syndrome, contact us for physical therapy treatment, so we can get you back on your feet!

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