There are many names for the most common injury runners present with. You may have heard of chondromalacia patella, peripatellar pain, retropatellar pain, anterior knee pain, runners’ knee and patellofemoral pain syndrome. All these terms are interachangeable and describe a gradual onset of vague pain around the patella (kneecap) area. The typical sufferer of such knee pain is a runner who is increasing their mileage.
Pain is initially reported as a vague soreness around or under the patella. The trigger is often a long run after prolonged sitting or from a knock to the patella. It can be aggravated by ascending the stairs or hill running.
Initally the symptoms will settle during a run and return when you stop running or later in the day. At this stage, many people keep running as they feel it must not be a serious problem if the pain is infrequent.
Continuing to run with this pain will make it significantly worse and eventually you will not be able to run at all due to severe pain (and sometimes swelling) in and around the kneecap area.
Once you are at this stage of injury, it is much harder to return to full, painfree function and can take many months of resting from the hobby you love while you address the cause of your pain.
The cause of this non-traumatic knee pain is a “tracking” abnormality of the patella. As the knee flexes and extends, the patella glides or tracks up and down in a groove of bone on the bottom end of the femur (thigh bone).
When the knee is fully extended the patella is above the groove on a fat pad. When the knee flexes, there is greater contact between the bony surfaces of the patella and the femoral groove. Tension in the patellar tendon increases as the knee bends, which increases the compression between these bony surfaces.
There are several factors that affect the tracking of the patella:
1. Tight lateral knee structures (these are the structures found on the outside of the knee, such as the Iliotibial band, the vastus lateralis part of the quadriceps muscle & the lateral retinaculum) coupled with weakness in the vastus medialis part of the quadriceps muscle on the inside of the knee can disrupt the balance of the patella position. Under these circumstances, the patella moves towards the outside (laterally) as the knee flexes. This causes pain under the patella when the quadriceps muscles contract.
2. Biomechanical malalignment is also associated with excessive lateral pull on the patella towards the outside of the knee. Your medial arch profile and tibia (shin bone) position will influence this.
3. The quadriceps angle (Q angle) is an angle formed by the line of pull of the quadriceps muscle and the patella tendon. Q angle greater than 20? is considered abnormal. This pulls the patella laterally as the quads contract as the heel strikes and also as the tibia internally rotates in mid-stance.
4. Patella alta (abnormally high patella in relation to the femur) predisposes the patella to lateral stress and instability.
5. Poor core stability with weak gluteus medius muscles can change the position of the femur which can rotate inwards too much, thus changing the position of the groove in which the patella moves.
It is vital to have an assessment with your local Chartered Physiotherapist who deals with running injuries.
You will need a biomechanical alignment assessment, to outrule any hip or pelvis abnormalities, a check of the balance of muscle strength and the soft tissues around the knee joint and the hip joint.
Treatment must be specific to you according to your biomechanics, your flexibility, your muscle strengths and weaknesses, your training programme and your competition goals.
A one size fits all rehabilitation programme will not work; it will only delay your recovery and frustrate you.
Tip:
If you have a history of injuries always on the same side of your body, you will need to improve your core stability. Get it assessed by your Chartered Physiotherapist today!
The typical sufferer of such knee pain is a runner who is increasing their mileage.
Pain is initially reported as a vague soreness around or under the patella. The trigger is often a long run after prolonged sitting or from a knock to the patella. It can be aggravated by ascending the stairs or hill running.
Initally the symptoms will settle during a run and return when you stop running or later in the day. At this stage, many people keep running as they feel it must not be a serious problem if the pain is infrequent.
Continuing to run with this pain will make it significantly worse and eventually you will not be able to run at all due to severe pain (and sometimes swelling) in and around the kneecap area.
Once you are at this stage of injury, it is much harder to return to full, painfree function and can take many months of resting from the hobby you love while you address the cause of your pain.
The cause of this non-traumatic knee pain is a “tracking” abnormality of the patella. As the knee flexes and extends, the patella glides or tracks up and down in a groove of bone on the bottom end of the femur (thigh bone).
When the knee is fully extended the patella is above the groove on a fat pad. When the knee flexes, there is greater contact between the bony surfaces of the patella and the femoral groove. Tension in the patellar tendon increases as the knee bends, which increases the compression between these bony surfaces.
There are several factors that affect the tracking of the patella:
1. Tight lateral knee structures (these are the structures found on the outside of the knee, such as the Iliotibial band, the vastus lateralis part of the quadriceps muscle & the lateral retinaculum) coupled with weakness in the vastus medialis part of the quadriceps muscle on the inside of the knee can disrupt the balance of the patella position. Under these circumstances, the patella moves towards the outside (laterally) as the knee flexes. This causes pain under the patella when the quadriceps muscles contract.
2. Biomechanical malalignment is also associated with excessive lateral pull on the patella towards the outside of the knee. Your medial arch profile and tibia (shin bone) position will influence this.
3. The quadriceps angle (Q angle) is an angle formed by the line of pull of the quadriceps muscle and the patella tendon. Q angle greater than 20 is considered abnormal. This pulls the patella laterally as the quads contract as the heel strikes and also as the tibia internally rotates in mid-stance.
4. Patella alta (abnormally high patella in relation to the femur) predisposes the patella to lateral stress and instability.
5. Poor core stability with weak gluteus medius muscles can change the position of the femur which can rotate inwards too much, thus changing the position of the groove in which the patella moves.
It is vital to have an assessment with your local Chartered Physiotherapist who deals with running injuries.
You will need a biomechanical alignment assessment, to outrule any hip or pelvis abnormalities, a check of the balance of muscle strength and the soft tissues around the knee joint and the hip joint.
Treatment must be specific to you according to your biomechanics, your flexibility, your muscle strengths and weaknesses, your training programme and your competition goals.
A one size fits all rehabilitation programme will not work; it will only delay your recovery and frustrate you.
Tip:
If you have a history of injuries always on the same side of your body, you will need to improve your core stability. Get it assessed by your Chartered Physiotherapist today!
