By Debra K. Brinker, RN
RUNNER’S KNEE- NOT ONLY IN RUNNERS
Also known as Patellofemoral Pain Syndrome (PFPS), runner’s knee is characterized by anterior knee pain. Sufferers of this condition commonly experience pain behind and around the kneecap or patella. Patellofemoral Pain Syndrome can affect one or both knees and is a knee complaint among athletes and non-athletes alike.
Besides the tenderness behind, around and at the center of the patella, there may also be pain toward the back of the knee. Crepitation or cracking sounds may be heard, as well as a feeling of instability in the knee joint. The pain typically occurs with activity and often worsens with activities that include steps, hills, and uneven surfaces. Going downhill or downstairs aggravates the condition. Pain can also be triggered by prolonged sitting, due to the extra pressure between the patella and femur during knee flexion. Straightening of the legs may decrease the discomfort. Squatting and kneeling also exacerbate the pain, which can be dull, sharp, or burning.
A CLOSER LOOK AT KNEE INSTABILITY
Several forces act on the patella to provide stability and keep it tracking properly, as it articulates with the patellofemoral groove in the femur. The patella not only moves up and down, but also tilts and rotates, allowing for various points of contact between the patella and femur. Repetitive contact at these locations combined with abnormal articulation of the patella, is thought to be the cause of the pain behind and around the patella in Patellofemoral Pain Syndrome. PFPS should be distinguished from chondromalacia, which is actual fraying and damage to the underlying patellar cartilage. Chondromalacia patella can be a cause of Patellofemoral Pain Syndrome, as can other anatomical and overuse factors.
One often overlooked culprit in knee pain conditions is joint instability. Knee instability can bring about the abnormal forces placed upon the patellofemoral joint. (See Figure.) For example, when the knee is flexed, the patella glides through the groove in the femur. If the bones in the lower leg are not aligned correctly, this gliding becomes abnormal. An overload on the patellofemoral joint occurs with flexion of the knee as this movement increases pressure between the patella and the various contact points with the femur. This abnormal tracking can lead to increased wear between the bone surfaces, pain, and eventually the loss of articular cartilage.
KNEE TREATMENTS TO GET BACK TO RUNNING
The common approach for Patellofemoral Pain Syndrome usually involves activity modification, anti-inflammatory medications, the RICE protocol (Rest, Ice, Compression, Elevation), orthotics and physical therapy with quadriceps-based exercises together with hamstrings, quadriceps, gastrocnemius, anterior hip muscles and iliotibial band stretching exercises. Strengthening of the vastus medialis may be helpful, and exercises such as cycling are recommended. These approaches may help temporarily, but often do not fix the underlying knee instability problem enough to allow a person to get back to activities, especially running, at the desired level.
Regenerative medicine treatments, such as Prolotherapy, to the medial side of the patella will strengthen the attachment of the vastus medialis to the patella. Prolotherapy is a natural injection therapy that stimulates repair to injured and arthritic joints. A sunrise view X-ray and functional assessment of the knee will reveal how the patella is tracking and enable the physician to recommend an appropriate protocol. (See X-ray) The resultant strengthening can help to pull the patella into the groove, stabilizing the movement and allowing for a realignment of the patella. By eliminating pain and increasing mobility, Prolotherapy can provide options for runners and non-runners alike who are interested in a Regenerative Medicine approach for long term results.
Ross A. Hauser, MD.
Danielle R. Steilen. MMS, PA-C
Timothy L. Speciale, DO