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Knee Pain in Runners — Patellofemoral Pain Syndrome

If you have ever felt pain at the front of your knee, you may be experiencing signs of patellofemoral pain syndrome (PFPS). The knee is made up of complex anatomy which means there are multiple ways pain can be triggered; however, many simple things can be done to help manage your pain and it’s important to realise the amount of pain doesn’t necessarily equal damage!

Behind the patella (knee cap) and throughout the knee joint is cartilage. This helps to provide a smooth, protective layer during movement, a low friction environment and helps to distribute forces within the knee. Changes in the quality of this cartilage are often found on scans and can be the result of previous injury, age and general use through-out our lives. We can sometimes slow these changes but stopping them isn’t really possible (or necessary for that matter). We can however use tools like exercise to help manage pain and improve our knee symptoms should we be experiencing them.

Often the tracking of our kneecap (patella) will be blamed for the pain experienced during PFPS and while we can often change your symptoms by addressing the tracking of your patella with exercises and taping, it’s more likely that we’re just unloading cranky and inflamed tissues and giving our brain a different sensation to think about, rather than actually changing the path that our patella takes as we bend and straighten our knee.

As mentioned above, pain may also present or become greater due to inflammation. Usually this presents after an injury has niggled for a while and we keep on keeping on (ignoring it). Lack of strength, changes in movement patterns, fatigue and large increases in exercise involving the knees can also lead to pain. All of these reasons generally result in us loading the knee in a way that it’s not used to and if we want to continue loading the knee in this way (for example we’ve started running because we have a goal of taking part in a fun run), then we have to find a way to increase the capacity of the tissues in the knee (cartilage, ligaments, tendons and muscles surrounding it) in a way that doesn’t continue to make the knee hurt more!

Age, previous injury and certain genetic makeups are factors related to the experience of PFPS. While these are out of our control, there are things that we can do to help such as addressing movement patterns, strength, endurance and the general health of your knee joint.

Runners and cyclists are usually at a higher risk due to the fact that they are doing repetitive, high impact movements that directly affect the knee joint. If you do feel this during or after running or cycling it is important to consider your equipment such footwear, bike set up and the surfaces you are training on. Good footwear, appropriate size and set-up of your bike, changing up running surfaces and choosing suitable distances and elevations can all help to change levels of stress for the knee joint.

Office workers or jobs where you sit down for prolonged periods of time can be a trigger for these symptoms, especially when the knee is already a little sore from other activities. Modifying your activity slightly such as regular walking around throughout your shift, changing chair height, using a stand-up desk and remembering not to tuck your legs underneath you when sitting can be of benefit and keep you working efficiently with more comfortable levels of pain.

Finally let’s talk about what we could be doing to manage the symptoms of PFPS. As mentioned, improving the strength of muscles around the knee is important. Towel squeezes (right), mini squats and lunges are some of the most beneficial exercise to strengthen them in the early stages when the knee is cranky. As the pain settles a little, we can begin to load them through range using exercises such as deeper squats, lunge variations and step-ups.

Foam rolling and massage therapy can help to manage the symptoms, but it’s important to recognise that these techniques generally only address symptoms and won’t necessarily address the cause of the issue (which as stated earlier is a lack of capability of the tissues in dealing with the activities you are doing). Taping can be used to help change the way your brain feels about the movement of your knee. This can often mean an immediate decrease in your symptoms which allows us to do more of the strength and endurance work that is required to address the root cause.

Listening to your body and understanding how it responds to stimulus are the best ways for progressing injuries and managing pain. This is where your health professionals can educate you on where your pain is coming from and how to relieve the symptoms. Movement is such a powerful tool for the body as long as we understand how to best apply to our situation. If you have further questions or would like to chat to us about your knee pain, head to our contact page and send us a message!