Patellofemoral Pain in Runners

Patellofemoral pain (PFP) is pain associated around or behind the kneecap; it is the one of the most prevalent running injuries, with 9 – 15% of the active population reporting PFP at one time or another. This pain in runners is debilitating, often varied in how it presents, and the true source of pain is very difficult to narrow down (Stefanyshyn et al. 2006; Barton et al. 2012).

“THAT’S A FACT: RUNNERS TEND TO OVERDO AND PUSH THROUGH PAIN”

Jean-Francois Esculier – The Running Clinic

Should I stop running?

When you get PFP it’s not to say you should stop running completely, but perhaps you can modify your training for the moment? Can you reduce the distance, or slow your pace down and see if this helps?

According to Esculier et al. (2017) you should experience no more pain than 2/10 (in a 0-10 model for pain with 0 being nothing and 10 being the worst possible pain) whilst running; have no pain after an hour stopping the run and have no pain the next day. They found that this simple guidance, then building this activity up gently, was found to be effective in treating PFP.

There is an agreement that the position and glide of the patella is influenced by the soft tissue and biomechanics of the general lower limb and the joints. This means that muscle imbalances can put certain stresses on the patella and can be a reason for your pain (Neal 2019).

The role of strengthening the glutes has shown to be important in runners with PFP– they need to manage 4 x your body weight whilst running (Lenhart et al. 2014).

There’s a good glute’s circuit by Tom Goom (running physio) to help get people started – this isn’t appropriate for everyone and always best to be assessed first, or consult your healthcare professional if you’re unsure.

What this all means?

The take home message is to adjust your running regime to a more manageable pain level and gradually build from there. Maybe you’ve increased your pace, distance or number of sessions recently and your body isn’t ready just yet and needs to build up slowly?

Evidence suggests that effective treatment is about modifying activity, strengthening and education tailored to the individual (Lack et al. 2015; Barton et al. 2015). Everyone is different and in injuries there’s rarely, if at all, a “one size fits all” approach.

At TA Physiotherapy we aim to incorporate this into our assessment and treatment. If you have concerns or feel you need a thorough assessment book with one of our physiotherapists or our running coach.

Aran Pemberton

Aran qualified as a Physiotherapist graduating from the University of Worcester in 2017. He has since been working within the NHS, rotating into different specialities such as the Emergency Department, Critical Care, Orthopaedics and MSK.  He has worked with people of all ages and different levels of health and fitness, encouraging exercise as an essential part of health and wellbeing and providing the best care for his patients.

Aran has a keen interest in soft tissue mobilisation and movement re-education as part of the rehabilitation process. He has an interest in sports injuries and has experience treating players and working with the strength and conditioning coaches under the physio in Worcester County Cricket Club.

References

Barton CJ, Lack S, Hemmings S, et al. The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning Br J Sports Med 2015;49:923-934.

Barton CJ, Lack S, Malliaras P, et al. Gluteal muscle activity and patellofemoral pain syndrome: a systematic review Br J Sports Med 2013;47:207-214.

Lack S, Barton C, Sohan O, et al. Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis Br J Sports Med 2015;49:1365-1376.

Lenhart R, Thelen D, Heiderscheit B. Hip muscle loads during running at various step rates. J Orthop Sports Phys Ther. 2014;44(10):766–A4. doi:10.2519/jospt.2014.5575

Neal BS, Lack SD, Lankhorst NE, et al. Risk factors for patellofemoral pain: a systematic review and meta-analysis Br J Sports Med 2019;53:270-281.

Stefanyshyn DJ, Stergiou P, et al.  Knee Angular Impulse as a Predictor of Patellofemoral Pain in Runners. The American Journal of Sports Medicine 2006, 34(11), 1844–1851.

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TA Physio

am driven and passionate about healthcare focused on delivering successful patient outcomes through personalised rehabilitation. So far, I have established a successful career in physiotherapy rehabilitation and gained valuable experience in contributing to marketing strategies within multi-national companies. In 2005 I graduated from UWIC with a degree in science, health, exercise and sport, and then specialised in Physiotherapy and graduated Coventry University in 2008. Since commencing my physiotherapy career I have gained valuable experience in musculoskeletal, sports rehabilitation, and community based neurological and falls prevention rehabilitation within the NHS. In 2010 I set up TA Physio to provide a personal and flexible service for clientele requiring sports rehabilitation, falls prevention & rehabilitation, musculoskeletal physiotherapy as well as bio mechanical assessment in North London. In 2011 I joined AposTherapy as a junior therapist and developed over 2 years to become a Senior AposTherapist in 2013. Recently I have been promoted to lead the London Clinic development and growth reporting directly to the UK Clinical Lead and overseeing ten members of clinical staff. The responsibilities included developing vital HCP links to build referral pathways, accountable for staff development and clinical needs of the AposTherapy London Clinic. In 2014 I provided physiotherapy to elite athletes at The Glasgow 2014 Commonwealth Games. I was based within the busy and dynamic polyclinic within the Athletes' Villages. The aim is to help Glasgow 2014 deliver a direct access physiotherapy service to the people at the heart of the Games. Specialties: Gait Analysis, Deviations and Gait Rehabilitation; Sports Specific Rehabilitation; Orthopaedic Post Operative Rehabilitation; Musculoskeletal Physiotherapy; Clinical Blog Writing; Development and Growth of Clinical Services; Presenting to Healthcare Professionals & Advisory Boards.