By: Dan Johnson, PT, Director of Rehabilitation Services
Runner’s Knee (patellofemoral pain syndrome) is among the most common problems we see in our Sports Medicine Program. Runner’s Knee affects many running athletes and some estimates state that this syndrome accounts for 25% of all knee injuries. Runner’s Knee is more common in females (2:1) and it frequently affects adolescents. The causes of Runner’s Knee appear to be multifactorial and include overuse, malalignment, and/or trauma. One commonly held theory relates to abnormal “patellar tracking” which results in abnormal forces being generated in and around the kneecap. You don’t have to be a runner to develop Runner’s Knee. This condition frequently occurs in any athlete whose sport involves running.
Symptoms of Runner’s Knee include pain coming from around the kneecap. Symptoms may come on gradually or acutely and at times may be precipitated by trauma. Many times athletes will state that their running activity/training may have increased prior to the onset of symptoms. Pain may occur in one or both knees. Pain is often worse with squatting, stair climbing, or prolonged sitting. At times, the athlete may feel as if the knee gives way or buckles. Sometimes they feel a catching sensation. Patients may describe popping or cracking.
Runner’s Knee is generally not a serious condition and usually responds to conservative treatment. Treatment depends on the severity of symptoms. Many athletes are able to continue to run or participate in sports while undergoing treatment. We generally allow activity to tolerance. If pain is severe and affecting performance, modified, non-impact loading activity can be prescribed. Icing and over-the-counter medications can help reduce the symptoms of Runner’s Knee. Rehabilitation exercise is the cornerstone of treating Runner’s Knee; however, there is no specific program that has been shown superior to others. In our center, we prescribe specific exercises to strengthen the knee extensors/flexors, as well as the hip and core musculature. We also prescribe flexibility exercise for the hip and knee. Other measures such as patellar bracing or taping and foot orthoses (over-the-counter cushioning or arch supports) can be useful in some patients, but generally are not considered first line approaches to treatment.
Only on rare occasions, do we need to seek the opinion of an orthopedic surgeon for Runner’s Knee. Surgical treatment for Runner’s Knee is only considered when a patient has failed conservative care for 6 to 12 months and the pain is significantly limiting their ability to function. The vast majority of patients we see with Runner’s Knee get better with conservative care.
Once symptoms improve, we always tell our patients that they should continue to do their exercises on a maintenance basis, generally three times per week. We also caution them to avoid what we call training errors. These include making slow changes in their running activity (conservative estimates are 10-15% per week). Care should also be taken when changing the terrain on which they run. An example would be going from running on flat surfaces to hill running. Running athletes should obtain proper footwear and replace them when worn. Serious runners should change shoes every 300-400 miles
Reference: UpToDate 2013