What is Patello-femoral Syndrome (Runner’s Knee)?
Patello-femoral pain syndrome (PFPS) is the medical term used to describe pain felt behind your kneecap (patella), where your patella articulates with your thigh bone (femur). This joint is known as your patellofemoral joint.
Symptoms of PFPS
- Dull ache behind or around the patella
- Increased pain with knee flexion such as running
- Your knee may catch when bending, and you may experience a painful grating or creaking sensation.
- Other activities such as walking down stairs, jumping, squatting or getting up after sitting for long periods of time can also result in symptoms.
Active people will mostly notice symptoms when starting new activities or increasing their level of intensity, especially with respect to high-impact sports. However, non-active people can suffer patellofemoral pain during routine daily activities as well.
Causes of PFPS
PFPS is mainly due to excessive pressure or load on the patello-femoral joint. Poor patella alignment also contributes to PFPS as over time it affects the joint surface behind the patella (retro-patella). Your patella normally glides up and down through the femoral groove and as you flex your knee, pressure between your kneecap and the groove increases. This is normal, however in PFPS this retro-patella pressure is further increased when the patella does not ride normally through the groove, but ‘maltracks’, meaning it travels more to one side, making it rub against the femur (thigh bone).
The main cause of patella maltracking is muscle imbalance, either from flexibility or strength. When one side of the thigh (quadricep) muscle is either tighter or stronger, it can result in the the patella being pulled out of the its groove. There are numerous causes of why muscle imbalances occur and these need to be identified in order to treat PFPS effectively.
Conservative Treatment of PFPS
Firstly, a detailed Biomechanical Assessment is performed with the aim of identifying any features that may change the normal function of the knee. This may include inspection at rest and during painful movements, range of motion testing and clinical testing.
From these findings, a treatment plan is developed specifically to you. Some aspects of the treatment plan may include:
- Activity modification. An initial change to your exercise regime or daily activities may be needed to avoid the condition getting worse. The introduction of a low impact alternate activity may also be of benefit such as swimming and also avoiding hill running
- Strengthening. It is important that strength is addressed for this condition so that the affected area can tolerate more load. This is done initially with isometric loading to load up the affected area in a pain free way. When pain has reduced a program for quadriceps strengthening will be incorporated. Hip muscle strengthening will also be included if found to be weak and having poor control.
- Ice. to ease pain and swelling. Do it for 20-30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain is gone.
- Manual techniques: mobilisations of the knee joint and patella can have a pain relieving effect.
- Adequate footwear. Supportive footwear may also be recommended to stabilise the foot and ankle.
- Orthotic Therapy: A custom orthotic device placed in your shoe can help address possible causative factors such as flat feet or high arch feet.
- Taping/bracing. Patella taping can help promote correct tracking of the patella
- AlterG Anti-Gravity Treadmill. Continuation of training on the AlterG to decrease the load on the knee joint whilst maintaining an exercise program.