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  • Dori Nissenson

Summer Series Part 3 - Runner's Knee


Woohoo!!! Summer is definitely here!

With this warmer weather, many of us are changing our exercise routines. We are exercising more intensely and in different environments. As a result, I am seeing an increase in exercise-induced pain syndromes in my practice.

This letter of my summer series will focus on knee pain, specifically patellofemoral pain syndrome or PFPS which is commonly called Runner’s Knee.

BUT….don't let the name mislead you ...Runner's Knee does not only occur as a result of running. Runner’s Knee can occur as a result of any activity that involves running, jumping and bending such as tennis, gardening and often times walking on uneven surfaces such as the sand on a beach or a trail while hiking.

Since these are all activities that we do in the warmer months, I thought it would be timely to give you some information regarding the symptoms and treatment for patellofemoral syndrome/runner’s knee.

What is Patellofemoral Pain Syndrome/Runner’s knee????

Patellofemoral pain syndrome/PFPS or Runner’s knee is a broad term used to describe pain in the front of the knee and around the patella or kneecap as it is commonly called. Symptoms are often relieved with conservative treatment such as physical therapy and activity modification until the painful structures heal.

Runner’s knee is thought to be caused by a problem in the way your knee cap moves on the thigh bone and more recently, by the way the thigh bone rotates under the kneecap.

There are a number of factors that will prevent the knee cap from moving properly and all of them cause abnormal stress on the cartilage on the underside of the knee cap. Since there are no nerves in the cartilage, the damage to it cannot directly cause the pain. It can, however, lead to inflammation of the joint lining and pain in the underlying bone which is what causes the pain that you may be experiencing.

What Causes PFPS/Runner's Knee???

Typically PFPS may result from the following:

1. Muscle weakness around the knee joint

2. Limited flexibility in the muscles around the knee joint

3. Previous surgery

4. Poor foot position: flat feet or really high arches

5. Your anatomy: the shape of your knee cap or the angle of the hip in relation to the knee joint can predispose you to PFPS

During the warmer months, there are slightly different risk factors for developing PFPS. These are:

1. Exercising outdoors on pavement or uneven surfaces such as sand or a hiking trail as we do in the summer months can cause stress to the knee joint and the soft tissue structures around it.

2. Many people exercise more frequently in the warmer months and as a result, the painful structures have a hard time healing because the knee joint gets little rest.

3. Many people wear sandals or warm weather shoes in the summer months. These shoes are generally not supportive and this lack of support may perpetuate painful symptoms at the knee joint.

Do You Have PFPS/Runner's Knee???

Below are the common symptoms that you may experience with patellofemoral pain syndrome(PFPS):

1. pain during exercise and activities that repeatedly bend the knee such as playing tennis, gardening, skiing, climbing stairs, running, jumping or squatting

2. pain after sitting for a long period of time with your knees bent such as at work, in a movie theater or when on an airplane

3. pain related to a change in activity level, intensity of the activity, playing surface or equipment

4. popping or crackling sounds in your knee when climbing stairs or when standing upright after prolonged sitting.

What Is The Treatment Of PFPS/Runner's Knee?

If you believe that you may have PFPS/Runner’s Knee, it is imperative that you seek the help of a physical therapist immediately.

If left untreated, PFPS may limit your ability to participate in your mode of exercise and may affect your functional abilities (i.e. walking and going up and down stairs). In addition, if PFPS worsens it may affect the hip, foot and ankle and even the lower back.

Your physical therapist will perform a detailed evaluation of your WHOLE lower extremity and will devise a comprehensive treatment plan that may include:

1. RICE:

a. Rest: Your PT may advise you to take a break from the exercise that is aggravating your symptoms. B. Ice: Your PT will advise you to ice the knee to minimize the swelling and decrease the pain at the knee joint. C. Compression: Your PT may advise you to wear a compressive device or he or she may tape you to relieve the pain and decrease any swelling in and around the knee joint. D. Elevation: If there is swelling in the area, your PT will advise you to elevate the limb to reduce the fluid accumulation in the joint.

2. Manual Techniques: Your PT will use soft tissue mobilization and joint mobilization techniques to correct your biomechanical alignment throughout the lower extremity which may have caused the PFPS. This mobilization will also help to decrease your pain.

3. Stretching: Your PT will stretch you and give you stretches to work on at home to lengthen the muscles around the knee joint so that they place less stress on the joint during movement.

4. Strengthening: Your PT will work on strengthening exercises for the muscles on the front, back and both sides of the knee joint to give the joint stability for safe return to sport or other activity.

5. Orthotics/taping: Your PT may decide that your knee symptoms are being worsened by your foot and ankle alignment. In this case, your physical therapist may prescribe and fabricate custom molded orthotics. Your physical therapist may also tape your knee to hold your kneecap in better alignment and minimize the stress on the kneecap and other structures around the knee joint.

6. Education: Your PT will educate you in proper footwear for your activity as well as joint protection techniques.

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