Treatment of Runners Knee - A winning multimodal approach!

Updated: Apr 16

Simply put, treating runners knee or patello-femoral pain syndrome is a complex beast. In this article we will look at what works based mainly on the research but i'll also drop in a few clinical gems which i've come across while treating 100's of frustrated runners with this injury.


If you've read Runfit's previous article 'Runner's Knee - What is it and what causes it?' you'll already know what to look out for when it comes to figuring out if you have runner's knee. The key causes being one or several of the following: muscle weakness, biomechanical issues, movement control issues, training errors or flexibility limitations. Well, muscle strength and flexibility are fairly straight forward to fix you may think and you are right if you have a motivated patient who is happy to commit to a structured, progressive rehab plan. The other two are slightly more tricky but lets do our best...


THE BEST evidence we have are a few studies (This one and this one) that have collected all of the research to summarise the most successful management techniques and have figured out that a few things physios are doing are just a plain waste of time. The key point to take from this research is that they promote above any single treatment technique is a multimodal management approach. This meaning, the use of a few different techniques is far more effective than just taping the knee and sending a patient on their way.




A combination of informative injury advice and education alongside a patient specific rehabilitation program, involving targeted strength exercises and adaptations to current training routines, are our best treatment options to improve symptoms and function in people suffering from Runners Knee.






Advice and Education:


This study was done purely with runners to look at the best outcome measures and the results were very interesting... The treatment group that did exercises along side receiving education and advice on their injury didn't have superior outcomes to the treatment group that just received advice and education. This emphasises the fact that good quality and individualised education and advice to the patient about the symptoms of their injury and modifications needed for their training is essential to improve their injury.

Key information required:

  • Diagnosis - Patello-femoral pain syndrome/Runners knee

  • What does that mean: The load you are putting on your knee is due to (insert specific causes - read this) and it is causing an irritation and pain under your kneecap.

  • How should I fix it: Best thing you can do is alter your training (insert specific training advice) and we can do some (strength/taping/acupuncture/stretching/orthotics/cross-training) Information about any biomechanical/gait issues can be helpful too.

  • Important to understand that if you fix the causative factors now and eliminate the pain you are likely to prevent making the joint condition worse in the future.

  • Reassurance - don't stress! If you commit to the plan we can resolve this.


Exercise program:


Two key muscle groups - Glutes and quadriceps. Jury is out on the best exercises for this particular condition and its important to get the right exercises for your knee! Some exercise will be perfect for rehab some knees and will aggravate other knees just making them more painful. The exercise program should be tailored to the patient specifically and needs to address biomechanical issues that are potentially increasing the load to the front of the knee such as, weak glutes and quads...


Early stage rehab ideas:


  1. Quad setting

  2. Clamshell

  3. Side lying leg raises

  4. VMO straight leg lifts (muncies)

  5. Glute bridges (add resistant band to progress)


Later stage rehab ideas:

  1. Crab walk (Side stepping with resistant band)

  2. Monster walk

  3. Single leg glute bridge

  4. Leg extensions with resistance

  5. Single leg squat/lunge (Add medial pull with resistance band)

  6. Some form of core - Plank with dynamic component my favourite


Key areas to stretch and foam roll:

  • Quad stretch and roll

  • Glute stretches/foam roll and release with massage ball

  • ITB foam roll

  • Hip flexors/TFL/hamstring should be addressed too.


Taping:


Simple K-tape techniques can be very effective for pain reduction for runner's knee. Best to get guidance of how to do this. We will have videos up soon but see youtube for many examples. I like this one... It doesn't have to be colourful and don't worry too much about how much stretch you apply. The key is to create some compression below the kneecap and be careful not to put the tape on top of the knee cap! This will compress it further and will result in more pain. Ask us for help if you need it.


Gait retraining:


You need help with this one. Feel free to send us a video of you running (easiest on a treadmill) and we can help you. Otherwise go and see a reliable physio or shoe shop to help with advice on where you can improve your walking/running gait. If you go to a shoe shop, understand they have an underlying motive to sell you shoes... A lot of this comes down to biomechanics and potentially the shoes you wear.


Orthotics:


Again, this isn't something you can decide yourself. You need professional help here and generally a podiatrist or a reliable physio can advise on orthotics and if you need them. Generally people that require orthotics will have a pronation issue when they are in the loading phase of their running motion. However, thats not to say that all people who have foot pronation need orthotics! Message us and we can either help or direct you to the right people if you think this is relevant to you.


Manual therapy:


Hmm. Most physios you runners go and see will probably give you a rub a dub dub to your knee/thigh? Yeah, unfortunately this isn't doing much but it does feel nice doesn't it... The truth is, the massage might be slightly helping with releasing the quad muscle or IT band but if you can stretch and roll everyday at home this is far more effective than a 10 minute massage once a week. Hopefully, while they do the massage they are giving you incredibly relevant and helpful advice as mentioned above, that is the most valuable thing they can provide!

Bottom line, having someone wiggling and rubbing the leg isn't well backed by research. But if this works for you and the advice that goes with the massage is appropriate and helpful, fill your boots!


Final words in summary:

Chances are, you need to alter the way you are training and getting the right advice, from the right people, in the early stages of the injury is crucial. While you may need to alter when and how much you are running, you may also be advised to do some specific exercises to improve your running biomechanics where you can with some super fun glute and quad strengthening exercises. And if you like, put some fancy tape on your knee to make you feel good and take some of the pain away.

Running with pain sucks! I know from experience and I'd love to help you avoid it or get rid of your pain.


Message us to let us know what you are struggling with here:


luke@runfitphysio.com








 

RUNFIT PHYSIO

©2019 by Online Physio Lab.