Runners and Knee Pain

posted at October 3, 2011

Over the last 10-15 years, there has been a dramatic increase in the popularity of running with a significant increase in the number of marathons, half marathons and 5k’s. Running is known to have a positive influence on a person’s physical fitness, as well as to reduce the incidence of obesity, cardiovascular disease, and many other chronic health problems. However, running may also cause injuries, especially to the lower extremities.

Numerous articles have reported on injuries to runners of all experience, with yearly incidence rates for injury reported to be as high as 90% in those training for marathons. According to a two-year study of more than 2,000 runners completed by the University of British Columbia, almost half of all injuries occurred at the knee, with patellofemoral pain syndrome making up 46% of those injuries. For all runners, it is important to be fully recovered from an injury prior to running a marathon. For runners with less experience a graduated training program that avoids any sudden increases in running load or intensity is best, as a higher risk for injury begins to occur once a threshold of 40 miles/week is crossed.

What are the common symptoms of patellofemoral

(PF) syndrome?  Usually this condition presents as pain on either side of the patella (aka kneecap) or on the front of the knee.  It is often described as a deep ache or a sharp pain.  In more advanced cases, symptoms of “grinding” or “popping” of the kneecap may also be present. It is often worse when going up or down stairs, squatting, sitting for prolonged times or after getting up from sitting for an extended period.

What are the causes of PF syndrome?

This is a complex condition with a variety of contributing factors. Most commonly it is caused by poor tracking of the kneecap on the femur-the long bone of the thigh. This may be due to imbalance in the thigh muscles, poor foot biomechanics, or weakness of the gluteal muscles at the hip all causing abnormal movement of the knee and kneecap, placing abnormal stress on the knee.
What treatments are available for PF syndrome?

Physical Therapy treatment involves identifying what the contributing factors are and addressing these through corrective exercises, manual therapy, taping and orthotics. Strengthening and re-education of the hip muscles, specifically the gluteal has been found to significantly reduce stress on the knee by controlling excessive motion of the thigh. Re-education of the quadriceps muscles has been shown to be beneficial in treating this condition as well. Taping of the patella may help improve the tracking of the kneecap and take stress off of the ligaments that stabilize the kneecap.  Appropriate footwear or supportive orthotics may need to be implemented if poor foot biomechanics are a contributing factor. Rest or modified activity from aggravating activities and sports may be needed to settle inflammation to allow therapy treatment to correct the contributing factors.

Physical therapy is an optimal treatment for patellofemoral syndrome in runners.  A rehabilitation program should be specifically designed to suit the needs of the runner so they can return to pre-injury status as quickly as possible. It should also include a home exercise program to maintain results and prevent reoccurrence of symptoms. At Results Physiotherapy, each patient is evaluated and treated for the specific movement dysfunction that may be contributing to their symptoms. A specific program is developed for each individual to optimize their recovery time and resume running as usual. A patient should consider manual therapy and exercise as a great alternative form of treatment for their issue.At Results Physiotherapy every therapist has been through specific training in the treatment of patellofemoral syndrome.  If you have been experiencing knee pain that has been unsuccessfully treated by medication or are only getting temporary relief it is time that you called to schedule an appointment for an evaluation. Most insurances do not require a referral from a physician for physical therapy.

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