Injury: Patellofemoral pain syndrome (runner's knee)

Gavin Burt breaks down this common and terribly painful injury.

by Gavin Burt

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How to treat PFPS

Where to go from here

If you think you have developed PFPS, it’s useful to ask yourself some questions - 

a) Have I increased the intensity, length or duration of my running by too much in too short a space of time?   I dont think i need to say too much about this as everyone harps on about the 10% rule! And for good reason. Every run will create a little irritation in all joints, which the body then heals and is stronger for it. If you increase training too quickly, your body simply has no time to heal the irritation before the next time you run. If this happens a few times you will start to hurt.

b) Are my running shoes giving enough support or cushioning to my foot (are they right for me?) or indeed are they worn out?  The cushioning of good new running shoes helps reduce the shock of foot impact reaching the knee. Of course, its even better to ensure you include grass or other softer surfaces in your training runs, rather than always pounding the tarmac.

c) Could I be doing too much jumping, plyometrics, squats or lunges in my cross training schedule?   These types of exercises really make you feel stronger, but can be so detrimental to our kneecaps if not done carefully or correctly. You’ll know if this is the main cause of your PFPS if simply removing any of these types of exercise reduces your symptoms..

d) Have I had in the last year or so a previous injury that was never treated that may have led to my body adjusting the way it works, resulting in PFPS?   The only real way of finding out the answer to this question is to go and see an osteopath or physiotherapist who is experienced in running biomechanics, and they can tell you by assessing the mechanical working of your body. However, you don’t need to be a rocket scientist or a brain surgeon to realise that one injury can lead to another. For PFPS this is particularly true if you have had a back problem, or if you have had any type of foot pain that causes you to adjust the way you run.

e) Could my style of running be putting too much pressure through my knee?   People who develop PFPS are often what I call ‘thigh runners’; when they run they bounce up and down a lot, with the shock being absorbed by the quadriceps (remember the ‘pulley’ analogy i mentioned?), and their centre of gravity is often just on top of their feet or behind their feet, running as if they have a rope around their waist and are being pulled forward by someone. PFPS is just one condition as a result of this type of running (others include groin pain, ITB syndrome, achilles tendonitis and shin splints).

The type of style change that can help improve or prevent PFPS is fairly simple to apply. Imagine that you have a rope tied around your waist, and the rope is tied onto a sledge behind you (I thought the winter analogy might be appropriate!), and that you are trying to run while pulling the sledge. Imagining running this way changes where you place your centre of gravity, so that you can start to activate the muscles at the back of your legs (your hamstrings and glutes) which will take the strain off your quadriceps and kneecap. A word of warning however, beware that leaning further forward does give one the tendency to run on the toes, making us more susceptible to shin splints and achilles problems. To avoid this, just imagine that you are landing and taking off from your heels, and not pushing off with the ball of your foot.. You know when you’ve got this right if when you toe off, you should not feel much pressure against the ball of your foot.

f) Could I be running asymmetrically due to some of my muscles being tighter on one side?   Now this is my all time most important running bugbear, and one that i bore my patients with day in and day out. So listen carefully, as i will say this only thousands of times! Everyone’s muscles are tighter on one side compared with the other. So why is it that when we stretch, we spend the same amount of time stretching for example both calf muscles?? Surely that just perpetuates the difference in flexibility that is already there? And surely that means that we would run asymmetrically, creating potential for all manner of running injuries?

Balance and symmetry is so important to healthy and pain free running, so when you stretch I would recommend doing the following - Starting with the calves, test which calf feels tighter by simply testing a stretch on each side. Identify the tighter muscle. Stretch the tighter side for 50% longer than the more flexible side. Do this protocol for every muscle that you stretch on a regular basis.

Dos and Don'ts - Next Page

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Discuss this article

As mentioned in the article, I think the majority of cases are caused by the quads stretch where runners pull their foot back up to their bum. It pulls the kneecap hard on the femur. It's a disastrous stretch. I see it all the time. Don't do it!

Posted: 04/01/2014 at 19:33



I have had knee pain since a cross training session ( lots of squat jumps) on monday night, running since has caused some discomfort so after reading this article I decided to go out for a short run yesterday and tried taking off and landing on my heels tricky but I think I got it right and my knee was fine while running but once I cooled down the pain started again now its a constant dull ache!! anybody know a running osteopath or physio around stratford upon Avon?  Thanks

Posted: 19/01/2014 at 08:54

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