Thoughts from the journey… Excerpts from a day in the life of Sherry McLaughlin

3Dec/090

Patellofemoral Pain – Runner’s Knee 501

After a week hiatus due to the Thanksgiving holiday, I am back into blogging action. Today's post will wind up our look at the five most common running injuries, and we picked the best for last.

Patellofemoral pain got it's nickname for obvious reasons. It is prevalent in runner's and information regarding its diagnosis, cause or treatment are vague at best. I thought I would start with a lesson about how the knee is built.

Crash Course in Knee Anatomy:

The knee is made up of the femur (thigh bone) and the tibia (shin bone) and the patella (knee cap). The patella has an interesting position in that sits between two big bumps of the femur (the femoral condyles), but it is tied to the tibia via the patellar tendon. Therein lies the rub (no pun intended). The femur takes it's cue from the hip. That is to say, the position of the seat the patella sits on is controlled from the hip above. The tibia takes its cue from the ankle and subtalar joint. The knee really is stuck in the middle with nowhere to run and nowhere to hide.

Can it be fixed?

Enough of that. Here is the point. It can be fixed, but not with just rest or medications. Sure, stopping running will eliminate the pain. But the pain will resume once you start running again if you don't address the cause of the problem.

For you runners out there, this means normal hip flexibility and normal ankle flexibility.

Try this test!

The squat test is a great test to try. Stand with your feet shoulder width apart and toes pointed straight ahead. Squat down as far as you can without your heels coming up off of the floor. What happens?

- If your knee falls in - stretch your calf muscle and strengthen the gluteus medius and maximus (your butt)

- If your knee falls out - stretch your ITB and gluteus medius and work on balancing on a foam roll to unlock your subtalar joint

- If your toe turns out - stretch your calf muscles and your lateral hamstring (the revolving triangle is our favorite for this)

- If you feel like you have to lean way forward or throw your arms in front or you will fall backwards, this is a sign of tight proximal hamstrings. We love the downward dog, the triangle and the revolving triangle for this!

To the clinicians:

Most people with unilateral patellofemoral pain have a pelvic asymmetry stemming from an SI joint problem. This will create a functional leg length discrepancy that can cause medial or lateral patellofemoral pain.

On your patient with this problem, make sure to check the following:

1. The Three Key Hip Test - 90/90 hamstring, piriformis and FABERS - and fix what you find!

2. Pelvic alignment - innominate flares, upslips, rotations and sacral torsions

3. Ankle dorsiflexion - in standing with gravity drop or anterior reach with the leg

4. Subtalar joint eversion - in standing with medial reach w/ the leg

Fix what you find on the table and then support your findings with a solid exercise program. Remember, if it is done right, exercises to solve patellofemoral pain rarely should be focused on the knee.

Now, get to work... there are a lot of laid up runners out there!

Until next time...