Understanding the Truth About Patellofemoral Pain Syndrome: Debunking Common Myths and Effective Recovery Strategies
What is a runner's knee?
Runner's knee, medically known as patellofemoral pain syndrome, is a common condition that affects runners and other athletes who engage in repetitive knee activities. It is characterized by pain around or behind the kneecap (patella), particularly when engaging in activities such as running, squatting, climbing stairs, or sitting for prolonged periods. The discomfort is often exacerbated by activities that put stress on the knee joint, and it can significantly impact a person's ability to participate in their favourite sports or even perform daily activities.
Although running has been linked to improvements in cardiovascular health, enhanced mental well-being, and a reduced risk of developing diabetes, it is also associated with a greater incidence of musculoskeletal injury. This paradox highlights the importance of maintaining proper form and techniques while running, as well as the necessity of incorporating strength training and flexibility exercises to mitigate injury risks.
The most significant risk factor for developing a runner's knee is having a previous running injury. This previous injury can create imbalances in muscle strength and flexibility, leading to altered biomechanics during running. Additionally, factors such as poor footwear, running on uneven surfaces, and inadequate warm-up routines can contribute to the likelihood of developing this condition.
Research indicates that a runner's knee can affect up to 15% of the active running population, making it a prevalent concern among both novice and seasoned runners alike. Understanding the underlying causes and risk factors is crucial for prevention and management.
How do you get the knee pain?
Several kinematic factors, including excessive frontal and transverse plane motion of the lower limb, commonly referred to as dynamic knee valgus, have been theorised to increase loading forces acting on the lateral facet of the patella. This excessive motion can lead to improper tracking of the kneecap during movement, resulting in pain and discomfort.
The troubling aspect of a runner's knee is that a staggering 91% of individuals continue to suffer from symptoms for beyond four years after the initial diagnosis. This chronic nature of the condition underscores the necessity for effective treatment strategies and the importance of addressing not just the symptoms, but the root causes of the problem.
While rest and ice are vital components in the initial phase of recovery, it is equally essential to address the underlying issues that contribute to the development of a runner's knee. Merely treating the symptoms without understanding the biomechanical factors at play can lead to a cycle of recurring pain and injury.
Research has identified several risk factors associated with the development of a runner's knee:
Increased peak hip adduction has been identified as a significant risk factor for knee pain development, particularly in female runners. This biomechanical alteration can lead to improper alignment and increased stress on the knee joint.
Significant associations have been found between altered biomechanics and the development of knee pain in runners. These alterations can stem from muscle imbalances, improper running form, or previous injuries that have not been adequately rehabilitated.
Increased forces at foot level, such as overpronation or supination during the running gait, are also recognized as risk factors for knee pain development in runners. These forces can affect the alignment of the entire kinetic chain, leading to compensatory movements that place additional stress on the knee joint.
How Can Chiropractors Help with a Runner's Knee?
Chiropractors can play a pivotal role in the management of a runner's knee through various interventions. Running retraining and targeted strengthening exercises have been shown to improve pain and function in runners experiencing knee pain. These exercises focus on enhancing muscle strength, flexibility, and overall biomechanics, which are crucial for maintaining proper alignment and reducing stress on the knee joint.
Running retraining works via a kinematic mechanism that aims to reduce peak hip adduction, thereby promoting a more efficient and less injury-prone running style. This retraining can include adjustments to running form, stride length, and foot strike patterns, all tailored to the individual's specific needs.
Additionally, adjusting the hip to improve biomechanics is essential in the healing process. Chiropractors can utilize various techniques, including manual adjustments, soft tissue therapy, and personalized rehabilitation programs, to address the underlying issues contributing to a runner's knee. By focusing on restoring proper movement patterns and enhancing overall function, chiropractors can help runners return to their sport safely and effectively, while also reducing the risk of future injuries.
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Reference
Neal BS, Barton CJ, Gallie R, O'Halloran P, Morrissey D. Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: A systematic review and meta-analysis. Gait Posture. 2016 Mar;45:69-82. doi: 10.1016/j.gaitpost.2015.11.018. Epub 2015 Dec 29. PMID: 26979886.
Esculier JF, Roy JS, Bouyer LJ. Lower limb control and strength in runners with and without patellofemoral pain syndrome. Gait Posture. 2015 Mar;41(3):813-9. doi: 10.1016/j.gaitpost.2015.02.020. Epub 2015 Mar 9. PMID: 25800001.
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