Ever had knee swelling, discomfort, or clicking/grinding? Congratulations! You could be the unlucky winner of Patellofemoral Pain Syndrome (PFPS), aka, “runner’s knee.” PFPS can be traumatically induced but it is much more likely that it is caused from muscular imbalance and cumulative overload. Runners knee is the most common cause of knee pain, affecting an estimated 25% of adults. (1) GASP- that is a LOT of knee pain.
Knees a symphony of crackle when you are doing things? Maybe PFPS is to blame!
Don’t let the term “runner’s knee” fool you though, PFPS can be caused by other activities that put repetitive stress on the knee joint. Jumping or playing any sport on a hard surface can also lead to PFPS. It has even been shown to affect 10% of young athletes, further demonstrating how common this syndrome is. (2)
PFPS is most commonly related to lateral tracking of the patella. (3) This means that as the leg is bending or straightening, the patella/kneecap shifts out of place- in this case, moving outward. This problem can be compounded by a person’s body anatomy as well as loss of core stability. (7)
Patients who are suffering from PFPS/runner’s knee typically experience dull peripatellar pain (meaning around the kneecap) which can be exacerbated by activities that load the joint. This can include long walks, running, squatting, jumping, kneeling, arising from a seated position or stair climbing- especially going down the stairs or a hill. Pain can be accompanied by swelling, crepitus (cracking), intermittent locking or giving way. (5)
Working on single leg exercises- one of the many types of rehab exercises we will assign for PFPS
Clinical evaluation of PFPS/runner’s knee will center around identifying factors that create an imbalanced force on the patella. Weaknesses in a patient’s quads or hamstring muscles increases their risk of developing PFPS. Weakness/imbalance in the gluteus medius is also common in patients with knee pain and can contribute to PFPS. (4) Patients experiencing anterior knee pain (front of knee) are more likely to have trigger points in their hip, thigh, and lumbar spine muscles. (8)
Our favorite business consultant showing excellent glute firing in a squat with the knee out position at the bottom- make sure your knees aren't caving folks!
A knee radiograph may be necessary to rule out fracture for patients with a history of trauma or osteoarthritis and also in patients older than 50. Radiographs may also be needed in cases of recent history of knee surgery, significant swelling, and in those whose pain does not improve with treatment.
Treatment for PFPS includes exercise, bracing, shoe inserts, among other fun things like Graston! (6) Management will begin with minimizing aggravating factors to long-term correction of functional deficits. Retraining faulty movement patterns is the ultimate goal here.
We will frequently do Graston on our PFPS patients. It ends up making you bruised- BUT, it works well to get the blood flowing in the tissues we are trying to work on!
If reading this made you think, “oh, that sounds familiar,” or even, "oh, those leg bruises look like a great time," come visit us! Perhaps chiropractic care can help you! Until next time friends, Dr. Amy
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2. Myer GD, Ford KR, Foss KD, Goodman A, Ceasar A, Rauh MJ, Divine JG, Hewett TE. The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clinical biomechanics. 2010 Aug 1;25(7):700-7.
3. Douciette SA, Goble EM. The effect of exercise on patellar tracking in lateral patellar
compression syndrome. The American Journal of Sports Medicine. 1992 Jul;20(4):434-40.
4. Ireland ML, Willson JD, Ballantyne BT, Davis IM. Hip strength in females with and without
patellofemoral pain. Journal of orthopaedic & sports physical therapy. 2003
5. Thomeé R, Augustsson J, Karlsson J. Patellofemoral pain syndrome. Sports medicine. 1999 Oct 1;28(4):245-62.
6. Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. The ‘Best Practice Guide to Conservative Mnagement of Patellofemeral Pain’: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med. 2015 Jul 1;49 (14):923-34.
7. Chaudhari AM, Van Horn MR, Monfort SM, Pan X, Oñate JA, Best TM. Reducing Core Stability Influences Lower Extremity Biomechanics in Novice Runners. Medicine and science in sports and exercise. 2019 Dec 17.
8. Rozenfeld E, Finestone AS, Moran U, Damri E, Kalichman L. The prevalence of myofascial trigger points in hip and thigh areas in anterior knee pain patients. Journal of Bodywork and Movement Therapies. 2019 May 14.