Patellofemoral Pain Syndrome (Knee pain)
What is it?
This is a common condition, often described as the most prevalent overuse injury of the knee. Symptomatic pain arises behind or around the kneecap, also known as the patella, and is likely to have a gradual onset rather than result from a single incident of injury.
Pain is likely to be associated with activities like squatting, running, using stairs, and potentially any movement where the knee is loaded in a flexed position, though it can also occur with prolonged sitting with the knees bent. Patellofemoral pain is a clinical diagnosis reached by excluding alternative and more specific conditions (e.g. patellar tendinopathy, bursitis, osteoarthritis).
What causes it?
There are likely to be signs of reduced muscular control and strength that are believed to contribute to biomechanical impairment of the patellofemoral joint.
However, given the slow onset of pain and its potential to then become persistent, like other overuse injuries, symptoms can be complicated with a growing belief that the condition is worse than it is (‘catastrophisation’) and fear avoidance (‘kinesiophobia’). This introduces the need to consider and resolve aspects of pain sensitisation and wider psychological factors to successfully treat the condition.
Rehab
There is a body of high-quality evidence showing the effectiveness of combining knee and hip exercises in the treatment of patellofemoral pain syndrome.
In the short-term, patellar taping, foot orthoses (to counter biomechanical issues, for example, relating to excessive rear-foot eversion and mid-foot pronation), stretching, and some hands-on therapy may be useful for reducing pain. These are not, however, believed to help beyond the short-term and exercise is currently seen as the critical element in a treatment programme. Similar to other conditions described as overuse injuries, the complete avoidance of pain-provoking movement and a ‘wait and see’ approach are not seen to be effective at improving pain and function.
Summary
- Often referred to as an overuse injury, rather than the result of a single incident.
- Pain can be felt behind or around the kneecap.
- Pain can be associated with running, squatting, using stairs and/or prolonged periods of sitting.
- It is important to speak with a therapist about strengthening the muscles around the hips and knees.
- The therapist will also assure you that complete rest is not the answer and movement is both ok and vital.
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Here's a great beginner workout for anyone looking to improve their strength and mobility with a few simple circuits. All from the comfort of your own home! There are four circuits in the programme: Upper body Lower body Core Balance Simply click on the workouts below to download or print them.
What should a programme be? A good exercise programme should be first and foremost FUN. This can mean numerous things; exercising with a friend, time to yourself, challenging exercise, not so challenging, being outside, etc, etc. The most important thing is knowing what you enjoy then you’ll continue with it. The best exercise is the exercise that gets done! The second most important ingredient is variety. Ideally your exercise programme should contain elements of cardiovascular exercise (anything that gets the heart and lungs working a little harder) and strength work. Cardio? As far as cardiovascular exercise is concerned, I’m a big advocate of doing it outside. Also as stated above make it enjoyable; walking or cycling with friends, swimming, etc. Ideally you get outside once a day and if you have a fancy watch that measures your steps, set yourself and your friends a target and encourage each other to achieve it. If you need the promise of a cup of coffee in the local cafe that is fine too. Strength? As we get older the amount of muscle we have slowly decreases, so it’s important for us to maintain it. A good strength programme will... assist in preserving a good range of movement of all your joints challenge your balance so as to maintain your confidence in your physical ability as well as maintaining and possibly increasing your strength And who doesn’t like the feeling of being strong?! So when planning a strength programme think of big movements like the sit to stand and the squat and press, the balance work and core stability. A Final thought Please stay away from the latest gadget or diet that’s promising quick results! Keep it simple and have lots of fun.
What is it? A painful overuse condition presenting as lateral knee pain, often brought on by running or cycling. The iliotibial band (ITB), is a thick area of fascia (connective tissue) which runs from the lateral aspect of the pelvis and inserts into the lateral aspect of the tibia. There is some debate as to which tissues are affected, however it is thought that the tightening of the muscles around the hips, results in the ITB becoming taught, which in turn creates pressure upon the lateral tissues around the knee. Typically the pain will feel sharp, and may appear at the same point or duration of the run, walk or cycle ride, it may feel like the tightness is building and forcing the individual to stop. The pain may also come on during a squat or walking down stairs. What causes it? It is very important to understand that there isn’t an issue with the tissues of the knee. The pain is being caused by the pressure being placed upon the tissues below the ITB, not the tissues themselves, rather like pressing down upon a bruise. Rehab Your therapist will need to know what activities you have been undergoing and how this may have increased, or changed since you began experiencing the pain. With this information it will be a case of load management or bringing any changes, such as hill running back in slowly. Filming your running gait is a useful tool, this may show you and the therapist that there are some movement patterns which are leading to the pressure build up. Running drills and/or strengthening exercises will then be offered as a treatment. Most importantly though, don’t stop running! ITB syndrome can be painful, however pain doesn’t always equate to damage and speak with us at ParnellHarper about your running programme and how much the knees are being loaded.
Does it work? Studies concerning static stretching have generally shown it does not have any beneficial effect on running performance, running economy, the alleviation of post-run muscle soreness, or help reduce the risk of injury. Indeed, a pre-workout stretching routine involving extended or prolonged static stretching may have a detrimental impact on performance, with the suggested cause being reduced muscle tension, particularly when linked to subsequent activities involving jumping, faster running, and more powerful movements. It is now recommended that a warm up should consist of a combination of – movement to raise the heart rate and warm the muscles, dynamic stretching in addition to the static stretches if desired – it is this rounded approach which will eliminate any of the negative impact of purely a warm up consisting of static stretching. So what are benefits of static stretching? At face value, the available research seems to offer little positive support for static stretching. While static stretching may feel good at the time, perhaps any perceived benefit is indicative of something that needs strengthening rather than the stretch itself being a solution. Anecdotal evidence from The Australian Ballet company pointed to a reduction in injury when static stretching was replaced with strengthening by loading through range. This typically means replacing longer, static holds with slow and controlled eccentric muscle movement e.g. heel drops for the calf. Perhaps static stretching may be a useful tool in identifying reduced joint movement or a lack of flexibility, where these may link to potentially adverse compensatory movements or negative patterns to the rebalancing of loads. Once identified, an appropriate strengthening programme would offer an opportunity for resolution. Summary We need to move away from using static stretching for some temporary ‘relief’, or feeling it’s the answer to relieve tightness within a muscle or across a joint. Certainly, we know that many running injuries are likely to be the result of ‘overuse’ – overtraining or insufficient capacity - and it is functional strengthening rather than stretching that is more appropriate to the solution. A logical conclusion to be drawn from this is that eccentrically favoured strengthening through range is potentially a more beneficial approach to flexibility.
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