Knee pain – how to deal with it and return to running pain free


Anterior knee pain

You’ve powered through 9.5km of your 10km run on a gorgeous Saturday morning. You are already envisioning enjoying your Saturday morning latte and paper when you start to feel this sharp pain under your kneecap. You keep running, thinking it will just go away. But it doesn’t. It gets worse. You end up stopping and have to walk home. You throw some ice on the knee and hope by your next run the pain will be a distant memory. But weeks pass and you haven’t been able to run due to this pain and that hope of the marathon you were training so hard for is starting to look in danger of crumbling as quickly as your knee. This feeling is terrible, felt by many runners across the world, and is commonly called “runner’s knee”, or more formally patellofemoral pain syndrome.

Here is a little background on one of the most common forms of running injuries and tips on how to deal with it to get back on the running track this summer.

What is patellofemoral pain syndrome (PFPS)?

PFPS is pain experienced in the front part of the knee, particularly on/around the kneecap (patella). The most common symptoms felt are pain during and/or after physical activity during bodyweight loading of the lower extremities in walking up/down stairs, running, squatting, and in sitting with the knees flexed. Anterior knee pain, chondromalacia patella, patellofemoral arthralgia, patellar pain, patellar pain syndrome and patellofemoral pain are often used synonymously with PFPS.

What causes it?

The 3 main contributing factors of PFPS are:
  • Poor alignment of the lower extremity and the kneecap (patella). This relates to the physical makeup of our body, such as the angle between our pelvic and knee bones, which can predispose to PFPS. Pronation (flattening of the arch) of the foot can also contribute to increased load through the PFJ.
  • Muscular imbalance of the lower extremity. There are specific muscles we require to function well and have adequate strength to allow us to deal with the demands of specific activities, especially highly loaded activities such as running and jumping. Our core stabilisers, gluteals, quadriceps and calf muscles are important in maintaining the stability of our lower limb when under load. If these muscles are not functioning adequately to support the lower limb, then other muscles will compensate to do this, resulting in unwanted tightness of these structures, which can lead to increased strain on the patellofemoral joint.
  • Our bodies have a threshold to which they withstand certain amounts of forces going through them. The patellofmeroal joint is no exception. They expose the lower extremity to 3 times your body weight when striking the ground on impact when running, so you can imagine the amount of forces this joint has to take over a 10km run! When a structure in the body is exposed to a load that it cannot withstand, our body will often respond with a painful stimulus telling us the body is in potential danger. Often athletes, particularly those weekend warriors, will either push too far or fast in a run or increase their mileage too quickly over time to which the knee cannot withstand. Ever wondered why that day you decided to go run 5km after a 3 year hiatus from running ended in you on the couch with a bag of ice?

What can I do to limit the pain and get back to running pain free?

PFPS is an injury that can last for a long period of time if not treated properly. There are many factors as mentioned above that need to be addressed to ensure long-term pain free activity.
  • Increase your flexibility–common areas that become tight that can contribute to PFPS are the iliotibial band, tensor fascia, latae muscle, quadriceps and hip flexor muscle groups. Releasing these through the use of a foam roller or spikey ball can ease this tightness and reduce the load through the PFJ.
  • Strengthen where you are weak- the gluteal and quadriceps muscle groups have been found to be key contributors to lower extremity function in running, which act to unload the PFJ. Exercises addressed towards strengthening these and your core stability muscles are key factors in the rehabilitation process of PFPS.
  • Ensure you have a good loading program- the duration, frequency and intensity of our exercise over time, particularly running, will determine whether our knees are in a safe zone to operate continuously without pain. Consultation with a physiotherapist to help outline a proper loading program is vital to not only avoiding knee pain but also preventing injuries of other structures in the lower extremity.

There are many factors that contribute to PFPS which need to be addressed in order to ensure your pain is relieved and remains that way into the future. Ensuring you have the correct footwear is also an important ingredient to pain free and happy running.

If you have any concerns about symptoms you are encountering with running, whether it be PFPS or some other niggle, contact Symmetry Physiotherapy to receive expert advice and help get you back to whatever it is you love.

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The Team at Symmetry Physiotherapy