Running Injuries: Patellofemoral pain syndrome (Runners Knee)
What is it?
The knee is the most common area to get injured in running and accounts for 41% approx. Benca et al 2020, Mellinger et al 2019.
It is the most common running related injury and can occur in females between 19-30% and in males 13 – 25%, Mellinger et al 2019.
In a consensus statement by Powers et al, (2017), they state:
- Impaired hip-muscle performance can result in excessive internal femur rotation.
- Altered ankle and foot strength, with mobility impairment may increase pronation and plantar pressure
- Impaired hip/trunk muscle performance in the sagittal and frontal plane.
- Lack of hip muscle capacity was also highlighted by Nunes et al, (2019)
How would I know if I have it?
- Pain in the front of the knee (around kneecap) that comes on gradually
- Can be a dull aching pain
- Can be painful sitting with your knee flexed for prolonged periods such as watching TV
- Going up and down stairs might hurt.
- You may have increased mileage recently
- You may have changed your footwear which alters your foot mechanics
- IT Band syndrome will feel more lateral and mainly hurt on the way down the stairs
- Patellar tendinopathy will feel just below the patella and pain will be on loading (it’s called jumper knee for a reason). The main difference is Patellofemoral pain can be felt resting with knee flexed, patellar tendinopathy probably won’t until you load it.
What can I do? (Top tip: only exercise when you’re pain free with this one)
- Decrease or stop running (for a short time)
- Non-impact activities for 2 weeks with a decent stretch/non-impact activity program (yoga), also isometric quadriceps contraction to minimise muscle atrophy.
- 2-4 weeks: Open chain exercises such as: Leg extension, hamstring curl, calf raises, glute bridges, hip flexor strengthening with a band. Proprioceptive work (balance)
- 4-6 weeks: Gradual closed chain strength program: Squats, deadlifts, lunges etc. 3 x 12-15 reps. (balance exercise should get more complex and include a movement component)
- Week 6-12: gradual return to running (small and often). Introduce plyometrics such as small box depth jump land on one leg. Increase the load in the strength work and use 6-8 reps’ range for 3-4 sets. Incremental running mileage increase.
- 12 weeks plus: Full pain free return: Keep up with the strength work, yoga and have regular de-load weeks during running to enhance recovery and minimise injury.
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