It’s been a while since I have updated this blog but I hope to do a series on knee pain, knee injuries and sport and particularly surrounding a condition called Patellofemoral Pain Syndrome (PFPS) often called ‘Runners Knee’.
Runners Knee / PFPS is the most common of all knee pain/injury. The pain tends to be under and around the kneecap. Anybody can suffer from patellofemoral pain syndrome but as its more popular name suggests it affects mostly runners and cyclists or even those who sit for prolonged periods of time in their jobs or daily living. A lot of professional cyclists will suffer from knee pain at some point in their careers but by far runners suffer the most. PFPS is the most common of all knee injuries in runners….and as we know with the latest fitness buzz in Ireland, there are alot of runners out there!
Getting the right care and treatment for ‘Runners Knee’ can be a challenge. Strengthening the quadriceps is by far the most common rehabilitation provided by therapists, followed by hip strengthening and quadriceps massage. Many of these approaches work but can also be of little value to long term sufferers of knee pain. Knee surgery should always be the last option.
In average cases the pain is not severe and can be resolved with basic physical therapy or physiotherapy. For me, myofascial release has proved to be a successful option but not traditional techniques. As it’s an area I specialise in I use a more modern approach to myofascial release. These techniques need very gentle pressure as a means of reducing the restrictions within the connective tissue and as a result the muscles. It not only allows the client to relax and avoid the ‘no pain no gain’ method but also the tissue relaxes slowly, unwinds and is spared from further strain such as deep tissue massage or sports massage.
Of course most people recover from Runners Knee without much difficulty and there are many therapists out there including myself stating that standard physical therapy and physiotherapy is enough. But for a lot of sufferers out there ‘basic therapy’ simply does not work. Unfortunately for difficult cases of ‘Runners Knee’ one of the only things that has been shown to relieve the pain is simply rest. The secret for a successful resolution of PFPS is often rest and avoiding the positions and activities that stress the patellofemoral joint.
If this is the case, – why can it be so difficult to recover from PFPS, I hear you say? It is very easy to stress the patellofemoral joint and even though many rehabilitation plans have the best of intentions, sometimes the ‘no pain – no gain’ to therapy where you have to withstand deep tissue work or doing exercises that are ultimately continuing to aggravate and irritate the joint further. For complicated cases one must be careful, disciplined and diligent about avoiding the activities that irritate the joint and these will often include activities that might not be very obvious to you. What seems like simple everyday activities, may actually be causing further strain to the knee. Driving in heavy traffic where there is a lot of clutch action can easily aggravate the joint further. Prolonged sitting with the knee flexed at a particular angle can aggravate the problem. It’s difficult but important to try figure these things out. Simply put, any repetitive movement that loads the joint needs to be ruled as an aggravating factor. These include how often you ascend or descend stairs, squatting and crouching – are these part of your training on a regular basis, sitting with the knees bent – determine what knee position makes it better or worse, driving, walking, running or cycling – some of these may be minor loading but it depends on how repetitive the action might be.
If you have been suffering with PFPS for a long period of time and have tried various forms of treatment and rehabilitation maybe take a closer look at your daily activities and what repetitive movements or lack of movements may be contributing to the slow recovery process.
Stay tuned for the next entry where I will discuss the role of other more accepted causes of knee pain and PFPS including the role of the IT band, q angles, pronation and flat feet and more.