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.
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 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.
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.