Introduction
Runner’s knee, scientifically known as patellofemoral pain syndrome (PFPS), is a prevalent issue among athletes, particularly runners. Its impact on training routines and performance underscores the need for a deeper understanding and comprehensive strategies for recovery. In this detailed exploration, we navigate through the symptoms, intricate knee anatomy, and effective methods for managing a runner’s knee, shedding light on crucial aspects that contribute to a successful recovery journey.
One important note is that many people have different understandings to what Runner’s Knee actually is. Some thing it’s PFPS, some think it’s patellar tendonitis, and some think it’s ITB syndrome when they speak of it. That’s why we refrain from saying “Runner’s Knee” to our patients, but instead we use more specific terminology when talking with our patients.
Common Causes of Runner's Knee?
Chondromalacia patellae generally occurs on the front side of the knee and that pain comes from the patellofemoral joint, which is where the patella glides on the femur. When the cartilage on the patellar or the femur become irritated and inflamed, pain is elicited.
So what are some common causes that we come across at Alliance Regen & Rehab in St. Pete?
1. Biomechanical Causes
- Limited joint mobility – where limitation in a specific joint is causing a abnormal movement pattern or compensation elsewhere. This can also cause excessive stress and loading patterns.
- Inherited anatomy – Inherited anatomical features like flat feet (pes planus) or tibial torsion, retroversion, anteversion, coxa varus or coxa valgus can create issues with joint alignment and joint loading overtime.
2. Neuromuscular Causes
- Hip Weakness – Weakness in the glutes (glute medius, minimus, and maximus) can lead to decreased dynamic knee control, which means that knee has issues staying in line with the hip and the ankle. This can create excessive lateral compression of the patella on the femur.
- Quad Weakness or Tightness – Quad weakness can lead to patellar femoral pain syndrome by causing improper tracking of the patella in the femoral groove, increasing stress on the joint and irritating the surrounding tissues. Tightness can have the same effect by pulling the patella upwards excessively.
- Foot and Ankle Deficiency – Improper foot and ankle stability can lead to issues like over-pronation that can lead to the tibia rotating inwards, thus driving the knee inward. That can result in excessive lateral loading of the patella. Check out or blog on posterior tibialis insufficiency if you think this may be a problem you deal with.
3. Overloading
- Sudden Increase In Mileage – increase in running or biking mileage that exceeds what the joint has handled before.
- Increases in Load During Exercise – Increases in weight during squats or depth of squats can cause excessive load and compression.
- Chronic overloading – High volume of stressing the knee can lead to degeneration of the cartilage.
Understanding Runner's Knee Symptoms
Understanding Runner’s Knee Symptoms: Runner’s knee presents an array of symptoms, each signaling underlying issues within the knee joint:
- Pain Around or Behind the Kneecap: Persistent discomfort exacerbated by activities such as running, squatting, or climbing stairs is a hallmark symptom.
- Swelling and Tenderness: Inflammation around the knee joint leads to visible swelling and tenderness to the touch.
- Crepitus: A distinct grinding or popping sensation may accompany knee movements, indicating irregularities within the joint.
- Functional Limitations: Difficulty in performing basic activities that involve bending or straightening the knee due to pain and stiffness can significantly impact daily life and athletic endeavors.
- Warming Up Phenomenon: Pain present at the beginning of a movement or workout, but as you ”warm-up” the pain disappears. Following the workout, the pain returns later that day or the following day.
Exploring the Complex Anatomy of the Knee
The knee joint is an intricate network of structures designed to support movement and weight-bearing. As a hinge joint, the knee mainly moves into flexion and extension, with some rotation happening between the tibia and femur.
- Patella (Kneecap): Positioned at the front of the knee, the patella shields the joint and enhances the leverage of the quadriceps muscles during movement.
- Femur and Tibia: The femur (thigh bone) and tibia (shin bone) form the primary components of the knee joint, while the fibula provides additional support.
- Ligaments: Crucial ligaments like the anterior cruciate ligament (ACL), medial & lateral collateral ligaments (MCL & LCL), patellar tendon stabilize the joint and facilitate movement.
- Cartilage: Articular cartilage along with the medial and lateral meniscus covers the bone surfaces, reducing friction and enabling smooth motion within the joint.
- Muscle and Tendon: Muscles and tendons cross the joint to help some with stability but to also to act upon the knee.
Strategies for Effective Management & Recovery
The first step in recovery is to get a thorough assessment by a sports physical therapist. This is important because of the complexity of the knee and the vagueness of symptoms. A physical therapist not only find the source of the pain, but they can also uncover the causes or contributing factors by spending ample amounts of time with you and analyzing functional movements.
Pro Tip: Not that seeing a ortho or physician is a bad thing, but doing so may not be the best and fastest option in most cases. What usually happens is a quick appointment that contains a vague diagnosis, a prescription to PT, and a out-of-touch suggestion to “rest it.” The alternative to a ‘physician in a traditional big healthcare system’ is to seek out a sports medicine physician that will spend more time with you, that does diagnostic ultrasound, and believes in non-operative treatments. These can be found at concierge practices and private practices. Seeing a PT is not the only option either, but doing your research on practices and providers will put you in the best possible situation!
Addressing runner’s knee requires a multifaceted approach encompassing various strategies. This begins with our Medical Running Analysis and continues with our Resilient Runner Program that utilizes:
- Movement Analysis & Running Analysis: Using video to analysis running form and other movements to determine potential movement impairments or areas of concern that may be contributing to pain.
- Pain Control & Recovery: Utilized initially to decrease pain and inflammation to allow pain-free movement and prepares the tissue to be loaded. This may involve soft tissue work, manual therapy, dry needling, isometrics, or other light muscle activation exercises. You can see our previous blog on isometrics strengthening for patellar tendon pain.
- Cross-Training and Low-Impact Activities: Incorporating activities like swimming, cycling, or using an elliptical machine provides cardiovascular benefits while alleviating stress on the knees. Your physical therapist can help substitute these activities prior to or in conjunction with a return to run plan.
- Biomechanical Corrections: Correcting biomechanical issues such as overpronation, squat form, knee valgus, or running form can mitigate pain at the knee.
- Strength & Plyometrics: Improving strength and eventually integrating quick movements like plyometrics that prepare the knee, patellar tendon, and other structures to handle the demands of running.
Why Choose Alliance Regen & Rehab
For those in St. Petersburg and Lakewood Ranch, Alliance Rehab and Rehabilitation offers comprehensive and specialized care for knee injuries and running injuries. Here’s why they stand out:
- Experienced Professionals: The team comprises highly trained physical therapists and sports medicine physicians with extensive experience in treating knee injuries, even in professional sports. They also have vast experience in running injuries, having seen over a thousand injured runners.
- Personalized Treatment Plans: Every patient receives a customized rehabilitation plan tailored to their specific needs and goals.
- State-of-the-Art Facilities: Equipped with the latest technology and equipment, Alliance Rehab ensures effective and efficient treatment.
- Holistic Approach: Emphasizing overall well-being, the center integrates various therapies and exercises to promote full recovery.
- Patient-Centered Care: The team at Alliance Rehab is committed to providing compassionate and patient-focused care, ensuring a supportive environment throughout the rehabilitation journey.
Steps To Start Your Rehabilitation Journey
- Consultation and Diagnosis: Schedule an appointment with a physical therapist or our sports medicine doctors at Alliance Regen & Rehab. They will perform a thorough evaluation to diagnose the underlying cause of your knee pain.
- Develop a Treatment Plan: Based on the diagnosis, your doctor will create a tailored rehabilitation plan that includes specific exercises and therapies.
- Regular Therapy Sessions: Attend regular physical therapy sessions where your progress will be monitored, and adjustments to the treatment plan will be made as needed. These usually occur 1x/week for an hour, but can sometimes require 2x/week.
- In-Office Imaging – Get fast and accurate imaging inside of our office without having to wait forever in the waiting room, days or weeks to get results back, or being exposed to radiation. We do this with diagnostic ultrasound imaging performed by our sports medicine physician, Dr. John Broussard, DO.
- Home Exercise Program: Adhering to prescribed exercises at home is crucial for consistent progress. Your therapist will guide you on the correct techniques and frequency and send videos to you through an app. It feels more like personal training than just boring exercises.
- Follow-Up and Maintenance: After completing the initial rehabilitation program, periodic follow-ups with your therapist can help maintain knee health and prevent recurrence of the injury.
Tips for Preventing Knee Injuries
- Warm-Up Properly: Always start with a proper warm-up before engaging in physical activities.
- Strengthen Hip & Ankle Muscles: Incorporate hip and ankle strengthening exercises into your regular fitness routine so you can be strong in the joints that are above and below the “hinge” knee joint.
- Maintain Flexibility: Regular stretching exercises can help maintain flexibility and prevent stiffness. That includes dynamic stretching, static stretching, foam rolling, and dry needling. Exercises may include a banded hamstring stretch, couch stretch, and a hip opener.
- Use Proper Techniques: Ensure that you are using the correct techniques during sports and exercises to avoid undue stress on the knee. That means keeping an eye on your knee alignment when doing squats or lunges.
- Listen to Your Body: If you experience knee pain, do not ignore it. Seek early intervention to prevent further damage and give yourself the best shot at getting fast return to play!
Conclusion
Runner’s knee presents a multifaceted challenge, necessitating a comprehensive approach to management and recovery. By understanding the symptoms, delving into knee anatomy, and implementing effective strategies under expert guidance, individuals can embark on a path toward sustainable recovery and enhanced performance in their athletic pursuits.
For more information or to schedule a consultation, visit https://thealliancerx.com/