Runner's Knee - Patellofemoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome is Commonly Known as Runner's Knee

Low angle view of a grimacing man wearing a knee support and holding his injured knee
Low angle view of a grimacing man wearing a knee support and holding his injured knee. Stockbyte/Getty Images

Patellofemoral pain syndrome (PFPS), often called runner's knee, refers to pain under and around the kneecap. The pain of PFPS may occur in one or both knees, and it tends to worsen with activity while descending stairs and after long periods of inactivity. Patellofemoral pain syndrome is often mistaken for chondromalacia, a condition which describes damage (typically softening) of the articular cartilage on the underside of the kneecap (patella).

What Causes Patellofemoral Pain Syndrome?

While the exact cause of patellofemoral pain isn't known, it's believed that the way the patella tracks along the groove of the femur can lead to irritation of the cartilage on the underside of the patella. The patella can move up and down, side to side in the groove, as well as tilt and rotate. All this movement means that the patella can have contact with many of the articular surfaces of the knee depending upon a variety of factors such as muscle strength and balance, overuse, and incorrect tracking. It also means that the cause of the pain may be from a variety of different factors.

What Can You Do About Patellofemoral Pain Syndrome?

Rest is one of the first treatment steps to reduce the pain and severity of patellofemoral pain and runner's knee. Reduce your mileage or turn to non-impact exercises, such as swimming, to keep your fitness level while allowing your knees to heal. (See: How to train through injury).

While many athletes can manage their own rehab program, ideally you would want a physician or physical therapist to learn the latest treatment options and learn how to perform the exercises correctly. Depending upon your diagnosis, there may be additional strengthening and stretching exercises you will need to add to your routine.

Hipe Strengthening for Patellofemoral Pain Syndrome

Recent information about patellofemoral pain syndrome points the focus on strengthening the hips to get the kneecap to track correctly. Research by the Department of Physical Therapy at Indiana University-Purdue University Indianapolis found significant reductions in kneecap pain when women runners were treated with a hip strengthening exercise program. Their study findings support the idea that kneecap motion is more influenced by the hip muscles than the quadriceps, as previously thought.

For this study, a small group of female runners with patellofemoral pain syndrome performed a twice per week hip strengthening exercise routine for six weeks. The exercises performed included single leg squats and a variety of elastic band exercises to improve hip strength.

Another exercise that has been found helpful for knee pain is the Side Plank Exercise to strengthen the hips.

Previous research on patellofemoral pain syndrome looked at the feet and the quadriceps as part of the problem. Some people have reported that using specific shoe insoles or strengthening the quads can reduce knee pain, and quad balance may still have a place in treatment.

Reader Comment About Patellofemoral Pain Syndrome

One reader wrote in regarding his own PFPS, saying:

"In my own case, tight ITBs and muscular tightness contributed, but the most significant factor was the imbalance between my vastus lateralus (strong) and my vastus medialus (weak, along with the adductors). Various exercises and weight training options can help (and have in my case) to ameliorate this imbalance -- and fairly quickly!"

Such muscle imbalance can best be determined by a specialist who will do muscle balance testing and determine what, if any, imbalance you may have. One of the strengthening exercises you would likely begin is for the quadriceps group to build the muscles that are responsible for the way the kneecap tracks.

Footwear and Patellofemoral Pain Syndrome

The footwear you choose can also be an important factor in recovering from PPS. High-quality shoes should be replaced every 300 to 500 miles for a runner. Shoe breakdown can result in more knee pain. Orthotics and arch supports may also be advised. Icing the knees after exercise has also been shown to decrease the inflammation and pain in the joints.

Patellofemoral pain can be hard to treat and may take considerable time (up to six weeks) to fully recover. So ease back into an exercise routine and maintain quadriceps strength, wear appropriate footwear, and rest at any signs of overuse, and PPS is far less likely to sideline you in the future.


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