Exploring Runner’s knee: Symptoms and Solutions

Patellofemoral pain syndrome, also known as runner’s knee, is a condition causing pain in the front of the knee. We think that misalignment of the knee or increased pressure behind the kneecap and the knee leads to joint irritation and inflammation. What is patellofemoral pain syndrome, and how do we manage it?

What is the patellofemoral joint? 

The patellofemoral joint (PFJ) is where the back of the patella meets the thigh bone (femur). The back of the kneecap sits in a grove called the patellofemoral groove. When the quadriceps muscle contracts, it pulls on the quadriceps tendon and the patella, causing the knee to straighten. The bony surfaces at the back of the patella and the femur are covered by cartilage, allowing smooth movement as the knee bends and straightens.

Generally, everyday movements that work the patellofemoral joint include squatting, walking up or downstairs, or getting up from a seated position. Usually, the patellofemoral joint works well. However, like other body parts, it is prone to overload or wear and tear, leading to pain.

Causes

Usually, irritation of the joint is caused by the following:

• Abnormal tracking of the joint, also known as malalignment

• Overuse of the joint from excessive running or cycling

• Poor biomechanics lead to increased pressure between the kneecap and femur

• Fall onto the kneecap, causing bruising and pain behind the kneecap 

How to diagnose patellofemoral pain syndrome 

Often, the correct diagnosis of runner’s knee is based on presenting symptoms. Some more common symptoms include pain behind the kneecap, discomfort with bending and straightening the knee, clicking or grinding with the movement of the kneecap, and knee stiffness.

Generally, when doctors examine a person with patellofemoral pain syndrome, findings include tenderness behind the patella and pain with specific movements such as a squat or lunge. Often, patients point to the front of the knee above or below the kneecap.

Overall, imaging, such as an X-ray or MRI scan is routine. Imaging often rules out other causes of pain at the front of the knee, such as patellofemoral arthritis, patellar tendonitis, fat pad impingement, pes bursitis, meniscal tears, and bipartite patella.

Patellofemoral pain syndrome vs. patellar tendonitis 

It is essential to differentiate between patellofemoral pain syndrome and patellar tendonitis, as the treatment is different. Generally, patellar tendonitis occurs more commonly in jumping athletes. Often, pain improves with activity, while PFJ pain gets worse. Also, the pain of patellar tendonitis is localised to the patellar tendon below the patella.

Patellofemoral pain syndrome vs. meniscal tear 

Often it is difficult to pick these two different causes of knee pain. In meniscal, pain is felt inside or outside of the knee. Also, there is often swelling, giving way, or locking, absent with patellofemoral pain syndrome.

How to treat PFPS 

Generally, the treatment of PFPS is conservative. Treatment aims to reduce the pressure behind the patella by improving the biomechanics in the lower limb. It would help if you worked with your physical therapist on the following:

• Strengthening the muscles supporting the knee and hip. The key is strengthening the muscles without increasing the pressure in the patellofemoral joint. Exercises that reduce the PFJ stress include straight leg raises, side-lying leg raises, clamshells, hip bridges, and squats.

• Improving the flexibility of the muscles in the leg. Common tight muscles include the hamstring, ITB, and piriformis.

• Changing the biomechanics in the foot to stop the foot from rolling in. We can achieve these changes through proper footwear or orthotics.

Other treatments include soft tissue therapy or massage to the lower limb and hip and taping or a brace for the kneecap. Sometimes, we suggest a short course of oral anti-inflammatories such as ibuprofen to reduce pain and allow rehab to continue.

Can I run with patellofemoral pain syndrome? 

Usually, yes, but it depends on how well you can control your knee pain. Also, running at a lower intensity and on flat ground is more tolerable.

What kind of knee brace for patellofemoral pain syndrome?

A knee brace or taping can help reduce pain during more proactive activities such as squatting or running. Overall, the type of knee brace is not that important. Evidence suggests that a simple neoprene knee sleeve is as effective as a more bulky knee brace.

Does patellofemoral syndrome require surgery? 

Overall, surgery is not effective in PFPS. Previously, surgeons performed a procedure called lateral release. However, studies suggest that lateral release is ineffective and could worsen pain. Recently, surgeons are perfohave performed operations that change the position of the patella on the femoral condyle— called tibial tuberosity transfer. However, the outcomes of this surgery are unpredictable. Think carefully before having surgery for patellofemoral pain. 

Are injections beneficial for PFPS?

Generally, we suggest you avoid injections for most cases of PFPS.

However, in cases of severe pain that does not settle with simple treatments, a cortisone injection into the knee joint can be helpful. Often, we find that a cortisone injection into the knee joint can provide relief for a few months and improve the effectiveness of physical therapy.

In addition, injections can be effective in patellofemoral arthritis. We use either hyaluronic acid or PRP in these cases.

Other commonly asked questions about patellofemoral pain syndrome: 

Can patellofemoral pain syndrome cause arthritis?

We are not sure.

While some cases of PFPS lead to arthritis, the majority do not. A recent review found a weak link between anterior knee pain and patellofemoral arthritis. Why some people develop arthritis while others don’t is unknown. Over an extended period, high forces behind the kneecap alter cartilage composition. Eventually, these high forces could lead to arthritis.

How long does runner’s knee take to heal? 

Generally, most cases settle with treatment directed at improving lower limb biomechanics. However, there is no quick fix for patellofemoral pain; some people take months to get better. The timeframe for recovery is based on many factors, including age, health, and whether the cartilage is damaged.

Final word from Sportdoctorlondon about Patellofemoral Pain Syndrome

Most patellofemoral joint (PFJ) pain cases will settle with a good rehab program from a physical therapist. In general, you should avoid injections or surgery.

Related conditions:

• Patellofemoral arthritis
• Fat pad impingement
• Meniscal tear
• Pes bursitis
• Bipartite patella