5/351 Mona Vale Rd, St. Ives NSW 2075

(02) 8319 3642

Careers

FAQs

Book Now

Clinical Physiotherapy St Ives
M

Quick Links

No referral needed for Physio appointments

M
4

Back

Pain & Injuries

Rehabilitation

Sporting

Classes & Programs

M
4

Back

Clinical Physio’s Guide to Knee Pain for Runners (Patellofemoral Pain)

by | Aug 25, 2021 | Knee, Running, Strength

 

 

 

 

 

Patellofemoral Pain Syndrome (PFPS) or “Runners Knee” is one of the most common overuse injuries amongst the active population. PFPS accounts for approximately 15% of all knee pain, with females and young adults being 2 times more likely to develop symptoms due to PFPS (Boling et al, 2010).

What is the Patello-Femoral Joint?

The Patello-femoral joint is one of two joints that make up the knee (see figure 1). It is comprised of the kneecap (patella) and the thigh bone (femur) and provides the attachment sites for our quadriceps and patella tendons.

How do I know if I have PFPS?

PFPS is characterised as “pain experienced around or behind the knee cap, which is aggravated by weight bearing activities that require a flexed knee such as squatting, running, jumping and hopping” (Crossley et al, 2016). It is not uncommon to also experience symptoms such as:

  • Creaking/grinding sensations around the knee cap
  • Swelling around the knee
  • Pain provoked by pressing the knee cap
  • Pain bought on by non-weight bearing activities such as sitting

Figure 1. Patello-Femoral Joint

How did I get PFPS?

Runners often develop PFPS due to a combination of several factors such as:

  • Muscular weakness (Quadriceps/Glutes)

  • Muscular tightness

  • Changes to training loads

  • Inappropriate footwear

  • Anatomical variations in knee cap shape/position

  • Changes to running style

  • Biomechanical abnormalities

What can I do to recover?

Currently, the best treatment supported by research is STRENGTH!!!

Strength interventions have been shown to be most effective in relieving pain and improving function in individuals with PFPS. Exercise selection should be patient specific and target the hip external rotators/hip abductors (Glut Medius) as well as the knee extensor muscles (Quadriceps) due to their roles in knee biomechanics (Martin et al, 2018).

The great news is approximately 90% of individuals suffering from PFPS will be completely symptom free within 6 weeks of starting a strength rehabilitation program guided by a physiotherapist.

What won’t work long term?

Amongst the literature there is a lack of strong evidence, supporting the long-term use of:

  • Electrical Stimulation

  • Ultrasound

  • TENS (Transcutaneous Electrical Nerve Stimulation)

  • Massage

  • Biofeedback devices

  • Taping

  • Orthotics

  • Dry needling

  • Acupuncture

Although the majority of these things can help your pain in the short term, none have been shown to be superior to strength exercises of the quadriceps and gluteal musculature.

It hurts to run….what can I do?

Research on running mechanics has shown that stress on the Patello-femoral joint is greatest during mid stance and exceeds approximately 7x your body weight. This can be largely increased with

  • Slower speeds of running (Increase knee flexion)

  • Large vertical oscillation

  • Cross over style running

  • Excessive body twisting

  • Excessive body twisting

Ways in which you can alter your running technique to reduce knee joint stress by 15-20% are:

  • Maintain space between your knees when running (knee window)

  • Increase running cadence by 10%

  • Minimise excessive body twisting

How can I prevent getting sore knees?

Currently the best evidence for preventing future patella issues besides maintaining your strength is by assessing and monitoring acute: chronic training volumes in term of distance covered (Km). Acute increases in training volume should be no greater than a factor of 1.5 or you place yourself at an increased risk of suffering a subsequent injury.

We have covered this in depth in our blog titled Our Top 3 injury prevention strategies, which can be accessed by the link below:

https://www.clinicalphysiostives.com.au/blogs/top-3-injury-prevention-strategies-lessons-from-leicester-city

 

Ankle dorsiflexion knee to wall measure for squat

How to Treat and Manage Stiff Ankles

If your ankle mobility isn’t up to par, the next steps depend on the source of the restriction. Generally, if the limitation is felt at the front of the ankle, it may be due to joint-related issues.

  • Banded Ankle Mobilizations: This technique involves using a resistance band tied to a stable surface while performing ankle flexing exercises on a step. Check out this quick helpful video for guidance.

Conversely, if the tightness is located in the back of your ankle around the Achilles tendon region, consider:

  • Contract/Relax Stretches: A simple exercise like the bent-knee calf raise can effectively relieve restrictions in this region.

Lastly, for an immediate solution, consider using a wedge or support under your heels during a squat. Two papers from The Journal of Strength and Conditioning Research have shown that wedges can enhance squat depth without negatively impacting biomechanics. While some may see this as a “cheat,” the science supports it. If you struggle to achieve that 12 cm in the knee-to-wall test and find it challenging to squat low, use that wedge!

Hip Range of Motion

How Much Flexibility Do I Need and How Do I Test It?

For effective squatting, studies have determined that achieving 125 degrees of hip flexion is necessary—this is 35 degrees beyond a right angle. To test your hip mobility, you can use an inclinometer available on your iPhone. Simply follow these steps:

  1. Lie down on your back with your legs extended.
  2. Place the inclinometer length-ways on your thigh,
  3. Gently lift your knee towards your chest to measure the maximum angle, without moving the opposite leg.

     

    measuring hip flexion

    How to Treat and Manage Stiff Hips

    The hip joint is mostly passive during a squat, so if you’re experiencing limitations, it’s most likely due to an issue with the hip joint itself. There is up to 20% of the population that may be limited by the shape of their hip joint and the way it developed during childhood and adolescence. If that is the case, it makes if very difficult to improve the range of motion. Things like acetabular retroversion or a lower femoral head/neck offset ratio cannot be changed.

    For the rest of the population, here are some effective strategies for improving hip mobility:

    • Banded Hip Mobilisations: These exercises can help increase the range of motion in your hips by stretching and mobilizing the joint. Look for a demonstration in this video.
    • Inner Range Hip Flexor Strengthening: Strengthening your hip flexors can counteract tightness and enhance your ability to squat lower.
    • Like with ankle mobility, adding a heel wedge can help. By elevating your heels, you may experience a reduction in trunk forward bend, minimizing the hip flexion required and facilitating a more comfortable squat position.

    Conclusion

    Mastering a deep squat requires more than just strength; it hinges on sufficient ankle and hip range of motion. The studies from 2015 and 2022 have made it clear: flexibility in these joints is paramount for optimal performance.

    By regularly assessing your mobility and implementing these targeted exercises and techniques, you can improve your squat depth, enhance your overall strength training, and reduce the risk of injury. Remember, every body is unique, so listen to yours and adjust your approach accordingly. Happy squatting!

    Looking around? Filter or search below

    Ready to book with us?

    Choose who you want to schedule with from our team. Explore our recovery plans, crafted for faster return to health, with flexible payment options.

    Book now