Patellofemoral knee pain--runner's knee. (The Clinic).I have had problems off and on with runner's knee. Each time, I back off my training, both mileage and intensity, or rest completely, use ice, and cross-train in the pool and it goes away. Unfortunately, it always comes back when I try to re-establish my running program. Can you give me any information about what causes this irritating knee problem and what I can do about it? Jeff Murphy Silver Spring, MD Patellofemoral pain syndrome patellofemoral pain syndrome Sports medicine An often bilateral condition of insidious onset seen in young ♀ athletes Clinical Diffuse knee pain exacerbated by stair descent, squatting and prolonged sitting, patellar crepitus, knee joint stiffness, ↓ ROM. is typically caused by chronic overloading of the knee structures. Pain develops due to poor tracking of the patella patella (pətĕl`ə): see kneecap. in the femoral groove. For many runners, it is often a weak link that emerges as training increases. There are multiple alignment problems that can contribute to this including rotation of your femur, genu valgus valgus /val·gus/ (val´gus) [L.] bent out, twisted; denoting a deformity in which the angulation is away from the midline of the body, as in talipes valgus. The meanings of valgus and varus are often reversed. or knock-knees, leg length discrepancy leg length discrepancy Limb length discrepancy Orthopedics A difference in leg lengths, clinically significant at > 3 cm, affecting heart rate, muscle activity and O2 consumption Compensation strategies Steppage, circumduction, vaulting, hip hiking. (either functional, when running on the same side of a cambered surface, or actual), excessive curvature of your back (lordosis lordosis /lor·do·sis/ (lor-do´sis) 1. the anterior concavity in the curvature of the lumbar and cervical spine as viewed from the side. 2. abnormal increase in this curvature. ), hip flexor tightness, hamstrings tightness, weak quadriceps, imbalance between hamstrings and quadriceps, or other biomechanical problems. Erosion of the undersurface of the patella can develop as a result of chronic tracking problems. Since your problem is recurring and possibly chronic, it is not simply a result of overtraining overtraining training horses or dogs too hard so that they lose spirit. overtraining Sports medicine A general term for any practice of, or training for, a particular sport which is in excess of that necessary to participate in the sport , which . More likely, there is an underlying problem that results in poor patellar patellar of or pertaining to the patella. patellar cartilage a cartilaginous process borne on the medial side of the patella of horses and cattle. tracking. To treat these types of knee problems, you need a thorough biomechanical assessment looking at foot position, foot shape, knee position and stability, and position of your kneecap. An assessment for leg length discrepancy or pelvic tilt is also necessary. Treatment involves correction of any errors in your training, strengthening weak muscles (particularly the vastus medialis obliquus and the other quadriceps muscles), and increasing flexibility in overly tight structures. Certain modifications in your training can also help you avoid recurrent pain such as substituting some of your mileage with cross-training with water running, avoiding sprints with rapid stops and starts, avoiding hills, and including adequate rest and recovery. A good sports medicine clinic can help you make corrections and run pain-free. Mark Rubenstein, MD. West Palm Beach, FL |
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