Runners knee, otherwise known as patellofemoral pain syndrome (PFPS), as the name suggests, most commonly affects runners. It can however also be a problem for any individual whose activities require repetitive knee flexion, for example long distance walking, biking or any sport requiring jumping.
Symptoms commonly include tenderness behind or around the patella (knee cap), usually towards the centre. Pain can also be felt around the back of the knee and can be accompanied with a clicking/cracking sensation and/or a feeling that the knee may give way. Steps, hills, and uneven terrain tend to aggravate symptoms as does, fairly obviously, running. The pain can be sharp and sudden or dull, nagging and chronic in nature.
PFPS can affect either one or both knees. It most commonly affects younger, recreational runners and, according to the British Journal of Sports Medicine, twice as many women as men. This is because anatomically women tend to have wider hips, creating a greater angle between the hip and the knee (otherwise know as a ‘Q angle’), which can biomechanically put the patella under more stress.
It can be very difficult to pinpoint a singular cause of PFPS. It can come down to a structural issue where, for example, the patella is larger on the outside than it is on the inside, it may also sit high in the femoral groove, or be prone to dislocation. Worn cartilage can reduce shock absorbency, high arched feet can provide less cushioning while flat feet or knees that turn in or out excessively can all also contribute to pulling the patella out of alignment.
There may also be muscular causes. Tight hamstrings and calf muscles put pressure on the knee when it bends, and weak or unbalanced quads can cause the patella to be pulled out of line. Equally a tight and painful ITB or dysfunction of the stabilising hip muscles can be responsible.
So what can be done to prevent this sort of knee pain? Trying to run on softer more shock absorbent surfaces can help, as can keeping mileage increases below 10% a week, gradually increasing any hill work and being diligent with frequent, good quality stretching and strength training work. It is also very important to ensure your wearing the correct type of shoes for your running gait.
If you are unfortunate enough to experience symptoms try immediately cutting back your mileage. The sooner you reduce the impact on the knee, the faster healing can begin. It is also important to avoid repetitive knee-bending activities as well as, where possible, uneven surfaces, downward stairs and slopes until the pain subsides. As symptoms settle slowly rebuild mileage as well as trying to use a smaller stride on hills. Consider orthotics if new shoes don't fix the problem.
How can IFC help
- Prevention through running gait analysis
- Specific strength and conditioning programmes
- Manual therapy
- Massage techniques
- Symptom management