In medical terminology, “runners knee” is called patellofemoral pain syndrome (PFPS). It is a problem that responds very well to physiotherapy treatment and there is a reasonable amount of research evidence behind what we do. The pain arises from around or under the patella (knee-cap) and can be as a result of it not tracking properly in its groove. There are some common risk factors that can affect how the patella tracks.
How to treat it?
There are a lot of treatment options for patellofemoral pain and it normally responds well to physiotherapy. The treatment is not prescriptive and will depend on where you are in your training and why you have developed symptoms. The main treatment options are as follows :
- Education: understanding why you came to have this injury will help to avoid recurrence. This is a key part of the treatment. It is important to look back and see if you have made any training errors related to load or training surface.
- Rest or reduction in activity: mostly there will need to be some alteration in your running activity. If you are lucky, it might just be cutting this back a little but if the pain is too severe, you will need to rest to allow the irritation to settle. If you are training for a particular event then it is important that you keep up cardiovascular training where possible but using an alternative method that does not aggravate the symptoms until you are back to running.
- Taping: there is evidence to suggest that taping the knee can help in the short term to relieve pain and may allow you to continue running and start exercising the muscles in the thigh earlier. Some patients also find it helpful to use a knee brace.
- Correcting any biomechanical issues: this will involve assessing how you move, and using mirrors and videos to help to teach you new movement patterns. It is likely to involve improving glutes and quads strength and activation, and sometimes muscle stimulators may also be used to make changes more quickly if you are very weak. There are a number of different exercises that target these muscles, including squats, single leg squats and lunges. However, pain is a big inhibitor to muscle function so it is important that the exercises are comfortable. It is worth understanding that doing these exercises without appropriate instruction and supervision may worsen the condition.
- Soft-tissue release and stretching: each person will present differently. Some people have tightness in their calves, quads and hamstrings, and therefore soft-tissue release and stretching may be appropriate. Mobilisations to the ankle and around the kneecap may also be used. However, issues in flexibility as a primary factor are probably less common than strength and control issues with patellofemoral pain. This means that stretching/rollering alone is unlikely to resolve your symptoms.
- Orthotics: if you do roll your feet in excessively then you may need an orthotic device – an insole you insert into your shoe to help support your arch. This can be bought off the shelf or custom-made by a podiatrist. If your feet only roll in a little then you may be able to improve the position of the foot enough with the correct pair of trainers.
- Anti-inflammatories: if you are unable to carry out normal functional activities without significant pain, then a course of anti-inflammatories may be appropriate. If you are in training and have a race coming up, then – with the advice of a medical professional – it may be appropriate to run with some pain and use anti-inflammatories to reduce the symptoms. This course of action obviously risks masking the pain and should therefore be discussed with your doctor or therapist. If you choose to continue to train, despite pain, to compete in a race, it is important that you allow yourself time post-race to address thoroughly the issues surrounding why you developed the pain in the first place.