Patellofemoral Pain Syndrome AKA "Runner's Knee"

  • 18 Mar, 2021

Patellofemoral Pain Syndrome (AKA “Runners Knee”)

 

Patellofemoral Pain Syndrome (PFPS) is an umbrella term to describe poorly defined pain which may be about the front or around the patella.

 

It is the most common cause of knee pain in runners. However, many clinicians tend to steer away from using the term “Runner’s Knee” as it can be confused with other common causes of knee pain within runners (e.g. patella tendinopathy and iliotibial band syndrome).

 

The onset of pain is usually gradual, and worsens with lower limb loading (e.g. stairs, squatting, uphill walking or running). Pain may also felt with prolonged sitting or driving.

 

Because PFPS is so poorly defined, and does not relate to one particular structure (it’s an umbrella term) it’s usually a diagnosis of exclusion. What “actually” might be sore may be the synovial lining of the joint, the adjacent tendons and ligaments, the cartilage and/or neural structures.

 

What are the risk factors?

  • Like many running injuries, the first consideration is load management (i.e. avoiding doing too much too soon).
  • Poor running biomechanics (e.g. increased hip internal rotation, hip adduction and the knee falling in to valgus).
  • Reduced quadriceps and gluteal strength, however there is a possibility that this may not be a causative factor, rather as a result of having the condition.
  • Tightness in the calves, hamstrings and iliotibial band.
  • Females > Males
  • A more experienced runner, or a novice runner who runs less than 5hrs per week has shown to be protective.

 

Management:

  • Load moderation: reduce running load, allow sufficient rest, consider other ways to cross train. If choosing to cycle raise the seat height to reduce compression across the patellofemoral joint. If at work, put your feet up! This also decreases compression across the joint during “rest” time.
  • Gluteal and Quadriceps strengthening. Knee strengthening programs lead to a 65% decrease in pain and a 33% increase in function.
  • Hip strengthening programs lead to a 65% decrease in pain and a 38% increase in function.
  • Running retraining: increasing cadence to 110% of preferred step rate decreases force across the patellofemoral joint by 14%. Consider cueing to adopt a more forefoot strike, or to reduce peak hip adduction.
  • Taping: can help in the short term (up to 4 weeks)