Runner's Knee, Not Just For Runners

By Jennifer Gordon, MSPT, CLT

Have you ever tried to get up after sitting for a movie or a long car ride, and discoveredsharp, halting knee pain? Can you climb stairs without pain, yet going down stairs is a problem? If so, you may have Patellofemoral Pain Syndrome, also known as Runner's Knee.

Patellofemoral Pain Syndrome (PFPS) is the most common knee pathology that brings patients to a health care practitioner. Most commonly described as pain or tenderness in the anterior knee, it is usually worse with straightening the knee in standing after sitting, squatting, running, climbing or kneeling. Starting a new activity that involves repetitive knee motion, or increased activity intensity often precedes PFPS.

PFPS occurs when the patella creates friction and irritation as itglides over the femur in an abnormal pattern causing the joint surfaces to grind into each other, resulting in inflammation and kneepain. This abnormal tracking leads to excessive wear and can lead to arthritic degeneration. There may be acrepitus (creaking or popping) sounds when the jointis in motion.In more severe cases, the kneecap may sublux or dislocate.

It is unclear exactly what causes this abnormal tracking, but it is thought to be due to tightness of the quadriceps, hamstrings, or iliotibial band musculature and /or weakness of the quadriceps muscles. Other causes may include the bony alignment of the hips, knees or feet, resulting in excessive patellar stress. A recent study by Noehren andDavis found that a greater hip angle was consistent with runners who develop PFPS suggesting that these runners use a different muscle firingstrategy than those who remain healthy.

A physical therapist will review your health history, activity level, and perform a thorough examination including tests to evaluate your muscle length, strength and joint mobility. They may also assess your foot alignment and yourwalking/runningmechanics. Your treatment is likely to includestretching/strengthening exercises of the hip and knee, tapingor bracing of the patella, exercisesto improve your activity tolerances and performance,and modalities to decrease your pain.Recently, focus has been on the hip musculature, specifically the hip abductors (the muscles on the outside of the hips) for resolving this condition. Uhldetermined thatearly hip strengthening maylead to faster recoverythanwith early quadriceps exercises.

Patients with PFPS can recover completely, especially ifit is identified early.Surgery is rarely indicated for this problem.