Q: I have started to develop a pain in my right knee when I am running. It is especially bad when I run down hill but the pain is really difficult to pinpoint. It seems to move all around the front of my knee. It is also worse the day after my run. I haven’t noticed any specific incident and it is just getting worse and worse. What could it be?
A: This kind of generalized pain around the knee is often termed anterior knee pain, or more accurately ‘Patellofemoral pain syndrome’ (PFPS). It can be caused by a number of factors, but usually it is a biomechanical issue which causes misalignment at the knee joint. The most common problem is that the knee cap itself moves too far to the outside of the joint when the knee is bent. This is why pain is worse on downhill sections, as the knee bends more under increased force.
The knee cap, or patella, should glide smoothly within a groove on the front of the knee formed by the thigh and shin bones (Femur and Tibia respectively). In cases of PFPS, the knee cap tracks too far laterally. This can be for a number of reasons but the most common include:
- Tight muscles and other tissues on the outside of the knee and thigh which pull the knee cap outwards
- Weak or poorly functioning VMO (the tear drop muscle, just above and to the inside of the knee cap) which doesn’t control this outwards force.
- Weak hip abductor muscles which cause the thigh and so knee to fall inwards
- Tight groin muscles can exacerbate this
- Overpronation or flat feet also affect the alignment at the knee.
Successful treatment of this condition relies on correcting any of these biomechanical and muscle imbalance problems. Stretching and massage work to the lateral thigh and knee as well as the groin muscles can really help. Strengthening of the hip abductors such as Gluteus Medius will help to prevent the knee from falling in and working on building up the VMO portion of the Vastus Medialis muscle can help to control outward movement of the patella.
Other things to try include the use of a knee taping techniques to pull the patella inwards, a knee support with a patella buttress, and also insoles if you overpronate or have fallen arches.
For more information on the treatment and rehabilitation of Patellofemoral knee pain, please visit www.sportsinjuryclinic.net
