"Runners knee"

There are a variety of reasons why a person will get knee pain during or post running. The most common of these is a tracking issue involving the patella (knee cap). This condition is known as patella femoral pain syndrome (PFPS).

Poor biomechanics will result in the patella not tracking correctly against the femur (leg bone). To address this problem completely you need to correct the cause of the problem which is usually poor biomechanics, not just correct the symptoms such as a tight Iliotibial band (ITB).

Any weakness or poor dynamic control of the following muscles need to be addressed to minimise PFPS.

• Gluteus maximus
• Gluteus medius
• Vastus medialis obliquus (VMO)
• Transverse abdominals
• Peroneal longus
• Gastrocnemious    

In addition to the strengthening program, deep tissue massage, acupuncture or any muscle relaxation technique such as foam rolling should be used on the above muscle groups to ensure ideal muscle length tension is restored. It's also not uncommon for other muscles such as hip flexors, groin, quads, ITB and lower back to tighten up to compensate for poor biomechanics. 

Given the knee is a relatively simple joint compared to the hip, the majority of individual variance and muscle imbalances will occur at the hip. Two of the best exercises to prevent PFPS would be a single leg squat and a single leg hop, using these two exercises will incorporate all the essential muscles needed for correct biomechanics in a controlled and dynamic manner.

Technique is vital in both of these exercises to activate the right muscles. If done incorrectly the pain and injury will worsen. In most cases you may find the specific muscles groups to perform a single leg squat is lacking, therefore preparatory exercises will need to be given, such as a Clam Shell, Hip Hitches and Bridging, to name a few, can be performed.

Other parameters to consider are:

• Running technique: Over striding, running too upright instead of leaning into the run, not pushing off your back toe or completing the stride, feet crossing over the midline of your body, heel running etc will contribute to PFPS.
• Foot mechanics: pronation under load will effect knee position and significantly contribute to PFPS. Correct footwear and/or orthotics may be required.
• Running surface: Running around an oval the same way every time (inside leg and outside leg will use different muscles) will create imbalance, hill/stair running especially down is more likely to develop PFPS, hard surface increases ground reaction force which is more likely to develop PFPS, treadmill changes running mechanics involving less glute activation and therefore more likely to develop PFPS.
• Overuse: Adequate rest is important in any training regime. Tissue that is loaded whilst running needs adequate rest before being used again / reloaded. Studies suggest any longer than a 2 week break from running would require a reduction in training load once you return.
• Anatomical structure of bones: Everyone is different, a persons individual bone structure may make it difficult to contract certain muscles. Surgery maybe indicated to correct abnormalities. For example, an individual with a small patella is more likely to suffer from PFPS as there is less area for force to disperse and therefore greater wear and tear may occur.
• Gender: Medically women are more likely to get PFPS then men purely due to the fact they they have wider hips, predominantly due to the female reproductive structure. 
• Previous injury: Torn ligaments will result in muscles tightening up around the knee to help with stabilisation. This additional compression may increase risk of developing PFPS.

Examples of Client Intervention:

Recently a client was referred by her doctor to Bondi Platinum Physio with PFPS. After years of riding horses and restarting her exercise training regime, it became evident that my clients key stabilising muscles supporting her knees and hips were extremely weak, thus causing her knee caps to track incorrectly and rotate inwards. In order to prevent immediate surgery and to help my client build the correct muscle structure to her hips and knees rectifying PFPS the following treatment was provided:
Stage One: Pain control - Releasing tight muscles and mobilising joints stiffness which was causing the pain, was performed using  massage techniques. Muscle activation exercises was performed to stabilise hyper mobile joints. My client was provided with education to prevent further inflammation and injury whilst maintaining exercise.
Stage Two: Maintaining correct muscle lengthening whilst providing a gradual progressive exercise regime
Stage Three: Reviewing the exercise techniques provided to the client that once caused pain and corrective action given, where required. Liaising with the clients Personal Trainer to optimise best practice during the training sessions.
Stage Four: The final stage was ensuring the patients goals were achieved and they were able to perform all exercises on a regular basis that once gave them pain.

Should you believe you have symptoms as outlined above, please contact me at admin@bondiplatimumphysio.com.au