Description
Runners knee also known as patellofemoral pain syndrome (PFPS) and Anterior Knee Pain Syndrome (AKPS) is a condition in which the load placed through the knee joint exceeds its tolerance, resulting in irritation and pain of the knee (2,3,5). Imagine your patella/ kneecap is a train and your femur/thigh bone is the train track. In an ideal world, the train sits squarely on the track (groove of the thigh bone) and glides up and down with minimal friction as you walk, run, jump or climb. Due to muscle weakness, tightness, altered lower limb alignment and/or altered running mechanics, the ‘train’ does not glide across the ‘track’ as symmetrically as it should. This places an increased amount of pressure along the borders of the knee (2). Research indicates that (PFPS) accounts for 15%-45% of running-related injuries (2).
The cause
Mal-tracking/asymmetrical movement of the patella may be due to various contributing factors. These range from muscle strength imbalances, alignment issues of the lower limb, poor flexibility and strength of lower limb musculature and changes to training regimens in which the training volume, intensity and frequency are too high or increased too soon (1,2,3). Other external factors also include training footwear and terrain (2,3,5).
The assessment
Each patient with this condition has a unique cluster of contributing factors. Therefore, we at Floyd Lebatie Physiotherapy ensure that we carry out an assessment that is individualized, holistic and athlete-centered, comprising observational and objective measures. This includes gait analysis, running mechanic analysis and cadence. Furthermore, the assessment is broken down into objective measurements of muscle strength, joint range of movement, flexibility, and endurance. As part of an holistic approach, if required, referrals to other disciplines, e.g. Orthotists or Podiatrists, for footwear adaptations should be considered.
Management
During the initial stages of injury, it is essential that inflammation be managed in conjunction with a rehabilitation program and training regimen modification (1,2,3). At Floyd Lebatie Physiotherapy, the rehabilitation program will include gait re-education, strength and flexibility training as well as muscular endurance (1,2,3,4,5). Inflammation and swelling can be managed by ice application, compression bandages, elevation, activity modification and if necessary, anti-inflammatories. To facilitate optimal running mechanics, taping and bracing can be used (3,4). As symptoms improve, gradual increases in training volume, frequency and intensity can be made.
If you think you battle with PFPS, do not hesitate to make a booking and let us help you get back on track! To schedule an appointment, call 011 027 2111
References
1.Esculier, J.-F., Bouyer, L., Dubois, B., Fremont, P., Moore, L., & Roy, J.-S. (2016). Effects of rehabilitation approaches for runners with patellofemoral pain: protocol of a randomised clinical trial addressing specific underlying mechanisms. BMC Musculoskeletal Disorders, 17(5), 1-7.
2.Kunene, S., Nomathemba, T., & Ramklass, S. (2020). Rehabilitation approaches to anterior knee pain among runners: A scoping review. South African Journal of Physiotherapy, 76(1), 1-8.
3.Kunene, S., Ramklass, S., & Taukobong, N. (2019). Anterior knee pain and its extrinsic risk factors among runners in under-resourced communities in Ekurhuleni, Gauteng, South Africa. SAJSM, 1-6.
4.Pollatos, D., Chandolias, K., Giodamni, M.-A., Chalkia, A., & Trevlaki, E. (2021). Review of New Data in Physiotherapeutic Approach to Patellofemoral Pain Syndrome (PFPS). Journal of Biosciences and Medicines, 9(2).
5.Willy et al. (2019). Patellofemoral Pain. Journal of Orthopaedic & Sports Physical Therapy, 49(9), 1-95.