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Runner's Knee (Patellofemoral Pain Syndrome)

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Patellofemoral pain syndrome is an umbrella term referring to pain in the front of the knee and around the kneecap, or patella. 
&nbsp;

The term &ldquo;runner&rsquo;s knee&rdquo; is a misnomer since the condition doesn&rsquo;t only affect runners. It is also quite common in people who cycle, hike, or walk long distances.

Also known as patellofemoral pain syndrome (PFPS), it is one of the most common causes of anterior knee pain in adolescents and adults, with nearly 3-6% of people in the US presenting with the condition.

According to a study, women account for more than half of the cases of PFPS. Another study showed that around 3% of physically active youth without a history of PFPS developed it in 2.5 years of follow-up.<a href="#accordion">[3]</a> 
&nbsp;

Sign and Symptoms

The signs and symptoms of runner&#39;s knee typically include:

<ul>
	<li>Pain under or around the patella, often exacerbated by walking, running, squatting, kneeling, or going up and down the stairs</li>
	<li>A grating or grinding sensation during knee movement</li>
	<li>Mild to moderate swelling around the patella, along with inflammation and irritation of the surrounding tissues 
	&nbsp;</li>
</ul>

These symptoms can significantly impact an individual&#39;s ability to engage in physical activities and may lead to functional limitations. 
&nbsp;

Causes

The most common causes of runner&#39;s knee include:<a href="#accordion">[4]</a> 
&nbsp;

<ul>
	<li>Weak hip and thigh muscles</li>
	<li>Abnormalities in lower limb alignment, such as excessive foot pronation or genu valgum commonly known as &quot;knock-knee&quot;.</li>
	<li>Repetitive <a href="https://merisehat.pk/disease/stress">stress </a>on the knee due to physical activities like running, especially with sudden increases in training intensity or duration</li>
	<li>Direct trauma to the patella due to fall or impact during sports 
	&nbsp;</li>
</ul>

Diagnosis

The diagnosis of runner&#39;s knee involves a combination of clinical assessment and diagnostic tests.<a href="#accordion">[4]</a>

<ul>
	<li>Clinical History: Detailed inquiry into the individual&#39;s symptoms, aggravating factors, and activity patterns to understand the nature and onset of knee pain.</li>
	<li>Physical Examination: Assessment of knee joint alignment, patellar tracking, muscle strength, flexibility, and palpation for tenderness around the patella.</li>
	<li>Diagnostic Imaging: X-ray, MRI, or ultrasound may be used to visualize the patellofemoral joint, assess for structural abnormalities, and rule out other pathologies.</li>
	<li>Functional Tests: Single-leg squat assessment, for instance, may be used to evaluate movement patterns and identify any abnormal mechanics contributing to PFPS. 
	&nbsp;</li>
</ul>

Treatment

The treatment of runner&#39;s knee typically involves a multimodal approach. 
&nbsp;

<ul>
	<li>Physical Therapy: Targeted exercises may help improve muscle strength, flexibility, and movement patterns.<a href="#accordion">[2]</a></li>
	<li>Braces And Taping: Use of arch supports, knee braces, or patellar taping may improve lower limb alignment and patellar tracking during movement.<a href="#accordion">[1]</a></li>
	<li>Medicines: Pain relievers, including ibuprofen, acetaminophen, and naproxen sodium, help manage pain and inflammation, especially during acute exacerbations.<a href="#accordion">[5]</a></li>
	<li>Orthotics: These are customized shoe inserts that help take stress off the knee.</li>
	<li>Surgical Intervention: Arthroscopy or realignment may be considered if there are structural issues or if simple treatments don&rsquo;t work. 
	&nbsp;</li>
</ul>

Additionally, home care measures such as ice application after exercise and rest are important for symptom management and recovery. During recovery, it is also better to stick to knee-friendly or low-impact sports like swimming. 
&nbsp;

Complications associated with runner&#39;s knee may include:

<ul>
	<li>Reduced quality of life due to functional limitations</li>
	<li>Secondary injuries, such as patellofemoral osteoarthritis</li>
	<li>Psychological distress, especially fear-avoidance behaviors 
	&nbsp;</li>
</ul>

Common risk factors for developing runner&#39;s knee include:

<ul>
	<li>Gender &ndash; Women are twice as likely as men to suffer from runner&rsquo;s knee.</li>
	<li>Age &ndash; Teenagers and middle-aged people are usually the ones affected.</li>
	<li>Individual Health &ndash; Being overweight or obese, having tight or weak leg muscles, or having flat feet increases the risk of developing runner&rsquo;s knee.</li>
	<li>Certain Sports &ndash; Athletes or those participating in sports with frequent jumping or running are more prone to it. 
	&nbsp;</li>
</ul>

Common preventive measures for reducing the risk of runner&#39;s knee include:

<ul>
	<li>Building strength, particularly focusing on leg and hip muscles strengthening to improve joint stability during activity</li>
	<li>Gradually increase training intensity and volume, ensuring adequate rest and recovery periods to avoid overuse and repetitive stress injuries</li>
	<li>Moving safely</li>
	<li>Using appropriate footwear to support proper foot posture and lower limb alignment for respective activities<a href="#accordion">[1]</a> 
	&nbsp;</li>
</ul>

key points

<ul>
	<li>Patellofemoral pain syndrome is an umbrella term referring to pain in the front of the knee and around the kneecap, or patella.</li>
	<li>PFPS occurs due to muscle weakness, abnormalities in lower limb alignment, repetitive stress on the knee, and direct trauma to the patella.</li>
	<li>Diagnosis involves clinical history, physical examination, and imaging studies to rule out other pathologies.</li>
	<li>Treatment includes physical therapy, medicines, and surgical intervention.</li>
	<li>Complications of PFPS include reduced quality of life, secondary injuries, and psychological distress.</li>
	<li>Risk factors for PFPS include age, gender, individual health, and certain sports.</li>
	<li>Preventive measures include <a href="https://merisehat.pk/article/why-strength-training-is-a-miracle-fitness-routine">strength training</a>, gradual training progression, and the use of appropriate footwear.</li>
</ul>

[1] Collins, N. J., Crossley, K. M., Beller, E., Darnell, R., McPoil, T. G., & Vicenzino, B. (2009). Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. British Journal of Sports Medicine, 43(3), 163-168.

[2] Espí-López, G., Arnal-Gómez, A., Balasch-Bernat, M., & Inglés, M. (2017). Effectiveness of manual therapy combined with physical therapy in treatment of patellofemoral pain syndrome: systematic review. Journal of Chiropractic Medicine, 16(2), 139-146.