Common Running Injuries - Patella Femoral Pain

We've all had them, those little niggles when we're running. A twinge here, a bit of an ache there after a session that often goes away. But what happens when they don’t?!! Most runners either research Dr Google, get on Facebook or head into a running forum to ask advice, but then they're bombarded with opinions. Stretch this, ice that, don’t do this or 100% you must do this. The whole thing is a minefield with thousands upon thousands of different videos and blogs, with well-meaning advisors who unfortunately often don’t have a sound qualification backing up their two cents...

The reality is the simplest answer is often the right one and the more we start to over-diagnose and overcomplicate, the harder and more scary it becomes. So we are here to set the record straight with our most common running injures and simple tips/what you can do about them.

What causes injuries in running?
The majority of running injuries occur due to overload. This usually means that the tissue in the body can no longer handle the load that you are putting it under. This often happens when you change something in your program, i.e. increasing mileage, increasing pace or cadence, increasing frequency etc... you get the idea. This week we are starting with the most common running injury that I see in the clinic.

Patella femoral pain (or runners knee)

Patella femoral pain (or runners knee)

Cause: Poor tracking of the patella (when the knee cap doesn’t glide smoothly into it’s groove) leading to irritation on the underside of the knee cap and the surrounding structures.

Symptoms: Pain around the kneecap or along the outer or inner edge.

Aggravating factors: Any movement that increases the pressure or compression under the knee cap, i.e. activates the quadricep muscles as the knee bends. For example, squatting or bending the knee, kneeling, going downstairs and running (especially down hill).

Management: Offload to reduce aggravation, identify cause and address this, then gradually re-introduce load.

Offload: Reduce running distance by doing shorter runs or more interval style to reduce overall load. If the knee is still too irritable stop running and replace with another form of CV fitness (such as cycling or cross trainer).

Identifying cause: Have you recently changed your programme, increased speed, distance or intensity? Were these increases all at once, planned in small increments or large and sudden?

Muscle imbalance or weakness: Do you perform any strength work? We put 3 x bodyweight into each leg when we run and often our muscles cannot handle the work we are asking them to do over a longer distance. It's important that the muscles around the knee and pelvis are strong and working in the right order, or firing pattern, to allow proper tracking of the knee cap. It's often when these are not conditioned, combined with a change in training that the injury occurs. We discussed the importance of the gluteus medius muscle in a previous article.

Knee anatomy.png

However the quadricep muscles, especially the VMO (vastus medialis oblique) and gluteus maximus also need to be strong to help with correct tracking. Click below for 2 exercises that you could try to achieve this.

Side step ups

Reverse lunges

A shorter or ‘tight’ muscle will have an effect on the way your knee cap tracks but also on how much pressure occurs under the knee cap when the muscles contract. There are several around the knee that can affect this but the most important is the quadricep muscle group. If the lateral fibres are more dominant and ‘tight’ this can cause the knee cap to get pulled outwards while the VMO is not working hard enough, leading to poor tracking. This muscle can also cause the pelvis to tilt forward putting more load into the knee when running. Other muscles such as the hamstrings, calf muscles and adductors can also affect the knee, indirectly contributing to tracking issues. Addressing these shortened muscles will help reduce the load into the knee. Below are some examples of drills you could try, however if you are not sure please seek a physiotherapist for further assessment and advice.

Hip flexor stretch
Quad and hip flexor foam rolling

Running form: Running economy is important to consider with any injury. We have previously discussed hip drop while running but a common issue seen in runners with anterior knee pain is slow step rate with a heavy heel strike as well as over-striding. Often simply increasing step rate and reducing stride length can reduce pressure into the knees and reduce pain levels. If you think this may be something you're doing, see a physiotherapist or running coach for a proper running assessment to pick up easy changes to reduce your pain.

Down the chain: Finally what are your feet doing? Have you just changed shoes to a new brand or model? Have you started using some store bought inserts as someone told you your feet pronate? If you do not have a stable, well moving base then this can affect the whole chain and small changes can have large effects at the knee and hip.

Gradually reintroduce load: importantly if you have addressed these issues and you can hop without pain it's important to be sensible and gradually return to loading rather than trying to run your previous distances and times straight way.

Summary: Injuries don't need to be scary and often have a very easy fix. Don’t ignore them and if the injury is not resolving see a physiotherapist for a diagnosis and rehabilitation plan. We'll be bringing you more injuries over the coming months so please let us know if there are any you would like discussed!!

Written by Tessa Williams - CER Physiotherapist