Knee pain? Patellofemoral pain? Runner's knee?
Patellofemoral pain affects 1 in 10 males, and 1 in 5 females. With the name “Runner’s knee”, it is the most common injury seen in runners with close to 50% of runners experiencing this condition. In this article we discuss what it is, how we treat it, and what you can do to help it!
What is it?
Patellofemoral pain (PFP) often presents as pain around the front of the knee, around the knee cap (patella). Common aggravating activities including running, lunging, jumping, stairs, squatting & sitting. With runners it is often aggravated on hills.
We see this condition present at a wide variety of ages, often beginning in early adolescence. Unfortunately where we once thought this was a self limiting condition (goes away by itself), we now know that a lot of runners have ongoing issues with 71-91% reporting chronic ongoing pain up to 20yrs post diagnosis (Nimon et al 1998).
A thorough examination is important to differentiate this condition from other problems that can give similar symptoms (ie. patellar tendinopathy, fat pad involvement).
My knee clicks, is it normal?
Noisy knees (also known as crepitus) is common: a previous study that examined 250 asymptomatic knees, found that 99% of them had this crepitus. To read more about this, head to our blog here
Our thorough assessment for knee pain
At Health & High Performance we pride ourselves on a thorough examination to ensure an accurate diagnosis to then lead to targeted treatment, allowing you to get back running as soon as possible.
Firstly it is important to have a thorough discussion about your problem and some of the factors that may have contributed to it. This can include training errors (doing too much too soon & inconsistent training) or insufficient recovery (ie. high stress and poor sleep).
Our comprehensive physical assessment protocols for knee pain include:
mobility, strength & motor control of the lower limb
running technique assessments
Mobility assessments for knee pain
Lack of mobility in the hips, knees, ankles and feet can contribute to patellofemoral pain. Some of the common tests we utilize for assessing mobility for those with knee pain can be seen in the following video:
Motor control assessments for knee pain
Altered gluteal & trunk neuromuscular control and altered hip kinematics (movement) are often seen in those with knee pain. Some of the tests we will perform to assess motor control can be seen in the following video:
Strength testing for knee pain
Using a number of tests and utilizing our state of the art AxIT system, we can test both the strength and rate of force development for a number of muscles & movements.
Weakness in the muscles around the knee (especially the quadriceps) is often found in those with PFP and knee pain. Here are a selection of tests we will utilize to assess the strength of the knee muscles:
Core & Lumbopelvic strength
Decreased isometric trunk strength has been shown in those with PFP. Here are a selection of tests we will utilize to assess the strength of the lumbopelvic muscles:
Calf strength is especially important for runners, as this muscle group takes the greatest load in running. Weakness in these muscles can lead to an increased loading on the knee. Here are a selection of tests we will utilize to assess the strength of the calf muscles:
Decreased hip strength is often seen in those with PFP and knee pain. Rate of force development (RFD) also needs to be considered, research by Nunes et al revealed that those with PFP had a 50-65% decrease RFD of the hip extensors and a 33% decrease in RFD of the hip abductors. Here are a selection of tests we will utilize to assess the strength of the hip muscles:
Your feet are your foundation, so strong feet can help prevent issues further up the leg. Greater foot pronation, mobility and greater rearfoot eversion during functional tasks is often seen in those with PFP
Running gait assessment
Have you noticed that we are taught how to do many sporting skills such as tennis, golf and swimming, but rarely, IF EVER taught how to run properly?! Just like any sport there is a right and a wrong way to do things. Through poor running technique, many people put their bodies under a lot more load than it should be.
Some of the common running technique issues we see in runners with PFP include:
Increased vertical oscillation (up and down movement)
Hip adduction & Knee valgus
Lack of hip extension
Knee strategy in midstance
Running retraining may decrease pain in those with patellofemoral pain. There is often many retraining options but it’s important to consider how changes impact other areas (ie the foot and calf).
For more information on how running gait retraining can be used for runner's knee pain, head to our blog on this topic here
What can you do about it??
Firstly, it’s important to reveal which out of the above factors are contributing to your knee pain, as this will dictate treatment, so seek answers from a health professional that knows runners!!
Our approach to knee pain and PFP is three pronged and includes:
Manual Chiropractic Therapy (soft tissue, manipulative therapy): this can assist with improving mobility and helping to decrease pain
Active Care (dynamic rehabilitation, exercise therapy, movement modification, training load management and running gait modification): to help with strengthening, improving mobility and reducing your chances of re-injury
Lifestyle Advice (stress management, recovery, sleep, nutrition): to help accelerate your recovery and reduce chances of re-injury
Any areas requiring increased mobility can be targeted with specific exercises. The most common areas we see in runners needing increased mobility are hip extension, knee extension, ankle dorsiflexion and 1st toe extension. Some examples of exercises can be seen here:
Some of the ways you can improve your strength can be seen here:
Core & lumbopelvic strength
Decreased trunk strength has been shown in those with PFP and knee pain. Here are a selection of exercises that we may utilize to strengthen the core & lumbopelvic muscles:
Hip based exercises can be effective at restoring loss of strength and rate of force development around the hip for those with knee pain. They can also be used when more knee focused exercises are too sore to perform. Here are a selection of hip based exercises
Weakness in the muscles around the knee (especially the quadriceps) is often found in those with PFP and knee pain. Closed kinetic chain exercises generally better tolerated between 0-45 degrees and open kinetic chain exercises generally better tolerated between 90-50 deg. In this video we see some examples of knee based exercises we may prescribe.
Calf & Foot strength
Calf strength is especially important for runners, as this muscle group takes the greatest load in running. Your feet are your foundation, so strong feet can help prevent issues further up the leg. Here are a selection of exercises that can be used to strengthen these areas:
Hands on manual therapy
Manual therapy including adjustments, mobilization and soft tissue therapy can be effective to restore movement and decrease pain.
McConnell taping can be a useful taping technique to help those with kneecap pain, patellofemoral pain or runners knee. See the video here for instructions on how to perform this
How to modify exercises in the gym
Check out our blog on this topic which goes into further detail on how to modify common gym exercises to avoid aggravating your knee pain. Click here to read
Want more information?
We have written a number of informative blog topics on knee pain. Click here to read