If you are a runner, an athlete, or just fairly active and have developed pain around the front of your knee you may be suffering from Runner’s knee, or what the medical world calls Patellofemoral pain syndrome (PFPS).
Patellofemoral pain syndrome refers to pain at the front of the knee, in and around the kneecap. (The kneecap, or patella, is the triangle-shaped bone at the front of the knee joint. The pain usually is accompanied by tenderness along the edges of the patella.
PFPS often occurs in people who are physically active or who have suddenly increased their level of activity, especially when that activity involves repeated knee motion such as running, stair climbing, squatting, or repeated carrying of heavy loads. If you are older, you might have age-related changes that cause the cartilage on the under-surface of the patella to wear out. The result is pain and difficulty completing even the simplest daily tasks without pain.
Usually, patellofemoral pain is worse when you walk up or down hills or stairs and on uneven surfaces. This pain tends to increase with activity and improve with rest. You also may feel pain after sitting for long periods of time with the knee bent or occasionally hear or feel a “cracking” or “popping” when you bend or straighten your knee.
Current research indicates that PFPS is an “overuse syndrome,” which means that it may result from repetitive or excessive use of the knee. Other contributing causes may include:
These conditions can interfere with the ability of the patella to glide smoothly on the femur (the bone that connects the knee to the thigh) during movement. The friction between the under-surface of the patella and the femur causes the pain and irritation commonly seen in PFPS.
If you suspect you have PFPS a visit to your medical doctor and/or physical therapist is advised.
In physical therapy we use certain tests and measures to help diagnosis PFPS. In addition, we observe the alignment of your feet, analyze your walking and running patterns, and test the strength of your hip and thigh muscles to find out whether there is a weakness or imbalance that might be contributing to your pain.
Finally, we check the flexibility of the muscles in your leg, paying close attention to those that attach at the knee. Generally, x-rays are not needed to diagnose PFPS.
No two patients are exactly alike so the key to appropriate treatment is a customized evaluation and treatment program. Some of the treatments that help this condition are:
If the alignment and position of your foot and arch appear to be contributing to your knee pain you may benefit by getting a special shoe insert called an orthosis. The orthosis can decrease the stress to your knee caused by excessive rotation or impact during walking and running.
PFPS is much easier to treat if it is caught early. Early diagnosis and treatment by a physical therapist may help stop the underlying problem before it gets worse. Your physical therapist also can help you adjust your daily activities and teach you exercises to do at home to strengthen your muscles and bones and help prevent PFPS from recurring.
Darren Marchant, PT,MSPT,OCS
FIT Physical Therapy