As the weather warms up, people are beginning to come out of hibernation and become more active. More kids are running around and playing sports, and more people are walking or jogging outside. As a result, there is a high incidence of "runner's knee" or patellofemoral pain syndrome (PFPS). It is one of the most common conditions that physiotherapists see in their practice.
Overview
PFPS describes a pain in the front of the knee in and around the kneecap. When the tissues around the kneecap become inflamed or irritated due to various reasons, pain occurs. PFPS occurs commonly in teenagers (girls), manual labourers, and athletes.
Causes
PFPS may be caused by overuse or injury. In many cases, PFPS is caused by vigorous physical activities that put repetitive stress on the knee, such as squatting, jogging, and stair climbing. However, it is also commonly caused by malalignment or abnormal tracking of the kneecap on the thigh bone. When the knee is bent or straightened, the kneecap moves up and down in a groove along the thighbone, like a train travelling on a track. If there is a misalignment, the kneecap gets pulled out of its groove, like a train being pulled off its track, and this causes irritation and pain underneath the kneecap. Females often experience this tracking disorder due to the alignment of their pelvis and legs (females have wider hips compared to males). As a result, muscular imbalances and weakness in specific muscles of the hip and thigh exaggerate and worsen the condition.
Signs and symptoms
- Dull, aching pain on the front of the knee (around or behind the kneecap)
- Activity-related pain, especially during knee bending (i.e. going up and down stairs, squatting, jumping, running, etc.)
- Pain after prolonged sitting (i.e. in the movie theatre or on a long plane ride)
- Grating or grinding noise when bending the knee
- Swelling or fullness around the knee (sometimes)
Physiotherapy Treatment
- Rest: As PFPS can be an overuse/repetitive stress injury, resting it will allow the tissues around the knee to become less irritated and inflamed. This means taking a break from repetitive activities that may aggravate the knee. Aim to keep fit, but minimize the activities that cause pain.
- Activity modification: It may be required to change the way certain activities are performed. If pain is caused by sitting or cycling, this might mean adjusting the seat so that it's not so low. If pain is caused by running or jogging, it might be beneficial to change the surface that you're running on (i.e. concrete/cement versus grass versus treadmill). You may be required to change up your routine or switch to low-impact activities until the condition gets resolved.
- Modalities: Electrotherapeutic modalities, such as ultrasound, laser, and IFC/TENS will help to decrease inflammation in the soft tissues of the knee and reduce pain. Ice or heat may be beneficial in relieving discomfort as well.
- Acupuncture and dry needling: Acupuncture and dry needling aim to decrease the tension in the tight muscles that may be pulling the kneecap out of alignment.
- Manual therapy: Massage or soft tissue techniques are useful in relieving the tightness of muscles (in particular, the muscles of the side of the hip and thigh).
- Exercise: For PFPS, a corrective exercise program is the most important part of treatment. The goal of an exercise program is to fix the underlying causes of the knee pain in order to prevent recurrence. If the knee pain is caused by malalignment or tracking issues, an exercise program is required to fix it. This may mean strengthening the stabilizing muscles of the hips and feet or stretching tight muscles that alter the alignment of the kneecap. It's important to fix the muscle imbalances and biomechanical problems that are causing PFPS. In the long run, exercises are the most effective treatment, but it does take time to work.
- Bracing and taping: Taping and bracing are used to position the kneecap in the correct position to improve alignment and tracking. This may be used to alleviate pain and reduce stress on the underside of the kneecap. However, this is only a temporary fix.
Other treatments
- Orthotics (to correct the alignment of the feet and legs)
- Medications (to help with pain and inflammation)
- Surgery (no longer recommended)