What is it?
Our knees are complex hinge joints, designed to provide stability from side to side and smooth movement forwards and back as you walk, kick and run. The patella, or kneecap, is a small bone embedded in the tendon of the quadriceps muscle that protects the knee and also provides extra leverage to the quadriceps, amplifying their strength. The patella moves up and down in a groove at the front of the knee as the knee bends and straightens. Usually this movement is smooth, with little friction, however, if something causes the patella to move in a dysfunctional way, the soft tissue between the kneecap and the knee can become irritated, causing pain in a typical pattern. This condition is often referred to as ‘runner’s knee’, PFJ syndrome or patellofemoral pain syndrome (PFPS).
What causes it?
The patella usually sits in a balanced position in the shallow groove at the front of the knee and moves easily without friction. The patella is attached to the quadriceps muscle at the top and connected to the lower leg via the patella tendon at the bottom. When the quadriceps contracts, this pulls on the patella and acts to straighten the knee. If one side of the quadriceps is stronger or tighter than the other, it can cause the kneecap to pull to one side and over time become irritated.
There can be many factors that cause a muscle imbalance or weakness on one side of the quadriceps. In most people, the outer aspect of the quadriceps tends to be stronger and tighter than the inner muscle.
Certain postures and leg positions require the outer muscles to work harder and the inside muscles to become less active. Lack of arch support in your feet or simply a physical abnormality of the knee can also place stress on the movement of the patella.
What are the symptoms?
This condition is characterized by pain felt on the inside or behind the patella with activities that require repetitive bending of the knee. There may be a sensation of crunching, clicking or grinding and some people report that their knee suddenly gives way. The pain is commonly felt when running, going up and down stairs or when doing squats and is generally relieved with rest. The pain may start as a small niggle and gradually become worse over time.
How can physiotherapy help?
The first step in effective treatment is to exclude any other conditions and have a physiotherapist confirm the diagnosis. Your physiotherapist is able to determine which factors are contributing to this condition, which could include poor posture, a lack of arch support in your feet or poor running technique.
Once these factors have been identified, you will be provided with a specific treatment program to best approach your condition. PFJ syndrome usually responds well to biomechanical analysis and correction of any muscular weakness and imbalance. Having the correct shoes and orthotics can also make a huge difference. There are some short-term treatments, such as patella taping, dry needling, trigger point therapy and ultrasound, which may help alleviate symptoms quickly and keep you active while you address the other factors contributing to your pain.
Running is a great way to stay in shape, manage stress and increase your overall health. However, it’s not without potential drawbacks. While generally being a low-risk activity, there are a few injuries that commonly affect runners. As running is a repetitive impact activity, injuries can develop slowly and if left too long, then be difficult to treat. Here are three of the most common conditions faced by runners...
1. Runner’s Knee:
Runner's knee is a persistent pain on the inside of the knee caused by the dysfunctional movement of the knee-cap during movement. The knee-cap ideally sits in the centre of the knee and glides smoothly up and down as the knee bends and straightens, in a process described as tracking. If something causes the kneecap to track abnormally, the surface underneath can become worn, irritated and painful. The pain might be small to start with, however left untreated, can make running too painful to continue.
2. Shin Splints:
Shin splints (medial tibial stress syndrome) is a common condition characterised by a recurring pain on the inside of the shin. While the cause of this condition is not always clear, it is usually due to repeated stress where the calf muscles attach to the tibia (shin bone). Why this becomes painful is likely due to a combination of factors that can be identified by your physiotherapist to help you get back on track as soon as possible.
3. Achilles Tendonitis (tendinopathy):
The achilles tendon is the thick tendon at the back of the ankle that attaches the calf muscles to the heel bone. The amount of force that this tendon can absorb is impressive and is vital in providing the propulsive force needed for running. If the stresses placed on the tendon exceed its strength, the tendon begins to break down and become painful.
Your physiotherapist is able to assess any factors that may contribute to this issue, including footwear, training errors and any biomechanical concerns.
The knees function as hinges, allowing your legs to swing forwards and backwards smoothly as you walk, kick and run. The knee cap (the patella) sits at the front of the knee and has a variety of functions, including guiding the muscles that straighten the knee, protecting the knee joint and absorbing forces when the knee is bent. When something goes wrong and the patella doesn’t glide up and down smoothly, the soft tissue between the kneecap and the knee can become irritated, causing pain. This is called patellofemoral pain syndrome (PFPS), sometimes also referred to as PFJ syndrome, patella maltracking or runner's knee.
Pain is usually felt on the inside of the kneecap when running, squatting, jumping, bending, using stairs or hopping. Sitting for long periods of time or keeping your knees bent can also result in pain.
What Causes It?
The patella sits in a shallow groove at the front of the knee and usually moves up and down as the knee bends and straightens without too much trouble. The quadriceps muscles located at the front of the thigh contract and pull on the kneecap, which then attaches to the shin bone and acts to straighten the knee. If one side of the quadriceps is stronger or tighter than the other, it can cause the kneecap to pull more to one side and over time become irritated.
The cause of muscle imbalance or weakness can be varied. In general, the outer muscles of the thigh tend to be stronger and tighter than the inner muscles. If you have poor posture and hip position, this can cause the outer muscles to work harder and the inside muscles to become weaker. Lack of arch support in your feet or a physical anomaly of the knees can also contribute to this condition.
How Can Physiotherapy Help?
Diagnosing patellofemoral pain syndrome correctly is important because pain on the inside of the knee can also be caused by other injuries, dislocations, inflammation, arthritis and a variety of other less common conditions. With that in mind, it is helpful to know that your physiotherapist can diagnosis PFPS accurately and identify its likely causes.
Whether it is due to poor posture, a lack of arch support in your feet, or poor running technique, your physiotherapist will assess the problem and provide a specific treatment program to best approach your condition. PFPS usually responds well to biomechanical analysis and correction of any muscular weakness and imbalance. Having the correct shoes and orthotics can also make a huge difference. There are some short-term treatments, such as patella taping, dry needling, massage, trigger point therapy and ultrasound, which may help alleviate symptoms quickly and keep you active while you address the other factors contributing to your pain.
In the rare case that your condition is not helped by physiotherapy, surgery may be considered as a last resort. For more information, please ask your physiotherapist.