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.

Commonwealth Day #10 – Refection #5

Well the end is in sight for Glasgow 2014 Commonwealth Games and I’ve had a blast so much so I might go to Rio.

Working in the poly clinic as a physio to the athletes has been a once in a lifetime experience and taught me so much about the world of elite multi-sport events.

I have had the opportunity to work under a great physiotherapy in Lynne Booth and a fantastic team of physio’s from across the UK.

The next goal for me is to get My Physio in sport bronze award and then continue multi-sport event physiotherapy through UK Athletics and BUCS pathways.

Thanks for reading my previous blogs.

20140803-104137-38497049.jpg

Commonwealth Day #3 – Refelection 3

XX Commonwealth Games
XX Commonwealth Games

Commonwealth Reflection #3;

The Glasgow 2014 commonwealth games are now well and truly underway with Saturday 26th July promising to be a busy schedule of competition across various sports including netball, Judo, and tracking cycling. The athletes are in full swing and the medals are coming thick and fast with this in mind I undertook my third shift at the Games Village Polyclinic.

 

The What?

The poly clinic environment, as I’ve previously mentioned, is a fast paced and exciting environment but requires a cool and collected approach to ensure the athlete gets 1005 the elite care they deserve.  But sometimes the system can be slowed down with bureaucracy  with a classic example of this coming when SEM doctors require ultrasound scans for soft tissue damage. SEM had to refer to radiography for U/S and were unable to perform U/S sans themselves. So SEM referred to radiography but radiography would only do MRI scans due to higher sensitivity rates (1) (2).

 

 

Courtesy of Shoulderdoc.co.uk
Courtesy of Shoulderdoc.co.uk

So What?

The systems clearly works within the polyclinic with this clinic seeing upwards of 400 contacts in a day, but the system can be slowed down. Ideally, the SEM doctor would like to use U/S as part of the assessment process but this may not be time efficient. HCP’s need to carry out a full and thorough assessment of the presenting condition and provide appropriate care, which in this case involved using U/S scans for soft tissue injury. However the radiography preferred MRI scans for diagnostics which cost a lot more money to provide. The resolution came when SEM were finally able to use the diagnostic U/S scans for the athletes. This is by no way a criticism of the current system but goes to show with the best laid systems they need to be flexible to provide a high level of care within a high-octane environment.

 

Now What?

  1. Multi-disciplinary healthcare provision is idealistic and can work with clear and concise communication as well as team work to overcome problems.
  2. Systems and approaches to care provision need to flexible to ensure correct diagnosis and treatment are provided
  3. The athletes are the main priority and excellent care needs to be provided to ensure the best outcome for the athlete

 

Thanks for reading.

 

Tom

 

 

Reference:

1) B Hamilton, R Whiteley, E Almusa, B Roger, C Geertsema1, Johannes L Tol (2013); Excellent reliability for MRI grading and prognostic parameters in acute hamstring injuries; Br J Sports Med.

2) K M Khan, B B Forster, J Robinson, Y Cheong, L Louis, L Maclean, J E Taunton (2003); Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study; Br J Sports Med

 

 

'prehab not rehab'
‘prehab not rehab’

 

Commonwealth Day #2 – Refelection 2

20140709-092114-33674932.jpg
XX Commonwealth Games

Commonwealth Reflection #2:

Hello and welcome back. Thank you for reading my first reflection on my experiences in the Glasgow 2014 commonwealth games. After completing my first poly clinic shift, I was excited to get back in clinic and enjoy shift number two on Wednesday 23rd July, OPENING CEREMONY NIGHT

A little wiser from previous shift, I was feeling more confident in my new surroundings and raring to go one day before competition began.

The What?

So Wednesday turned out to be a quieter shift in the polyclinic due to preparation for the opening ceremony. Naturally, most the attendees were either competing the following day or an acute injury needing attention in preparation for the games.  The team scheduled to cover the evening shift was the same team I worked with the previous day, so I was glad to have some familiar faces in the clinic.

 

So What?

A number of athletes came to the polyclinic seeking intervention for strapping and taping, this is something that is usually undertaken by the national team medical staff but as some nations have differing budgets, not all nations have a full medical team at the games and so they optimised the services at the polyclinic.

Over the course my shift I assessed and treated athletes from sports including Judo, weightlifting, hockey and long jump. these four examples demonstrated a good variety of stage of injury and the appropriate treatment undertaken, difference in teams and the medical support available to prevent such injuries, and expectations from treatment.

– A Judo athlete attended clinic requesting strapping and taping for bilateral posterolateral corner of the knees. No pain upon assessment and so I taped the knees. I think there are many properties to tape and differences between tape and strapping but one underlying factor is the psychological impact it has. I believe that it gives competitors confidence to push their bodies to the highest level despite the absence of injury. In the injured athlete it can be high effective to stabilise a joint (i.e subluxed shoulder).

 

Patellar Femoral Compartment Stress
Patellar Femoral Compartment Stress

– I saw another weightlifter with acute patella tendon tendinopathy and high irritability, why is this a common occurrence? I could only assume it was due to an increased volume of training in preparation for the games. In an ideal world I would love to sit down with the athlete and analyse the training volumes to cross-correlate it to the onset of injury but in a fast paced environment like a polyclinic as well as communication limitations, this is unrealistic. If I were set within a national medical team I would use those skills to monitor injuries within training regimes and highlight these impacts on injury rates thus enabling a team to improve training and performance. These guys would benefit from some eccentric tendinopathy rehabilitation.

– I saw an acute adductor strain (Grade I – MRI confirmed) from one of the larger commonwealth teams and experienced first interaction with national teams doctor requesting treatment. As part of the immediate management, the athlete was put on cryotherapy in the shape of ‘game ready’. This device works by pumping ice cold water into a cuff that is attached to the athlete. The machine setting mean temperature, length of time and compression can be regulated by the clinician. Its a marvellous piece of kit to have especially as it addresses two of the five P.R.I.C.E principles for the immediate management of soft tissue injuries.

Now What?

  1. Its important as a clinician that all patient are thoroughly assessed especially if we have not assessed or don’t know anything about the athlete
  2. Don’t just do what the athlete thinks will help. Clinically reason the problem and take suitable action in the form of treatment
  3. Taking treatment requests from medical teams is acceptable but again question the reasons behind the intervention.

 

Thanks for reading, hope you enjoy the blog, watch this blog for more Commonwealth games posts

 

Tom

Enjoying Games Life
Enjoying Games Life