Revolution Physical Therapy

“Runner’s knee”: Anterior Knee pain in the Runner

Anterior knee pain can be given many diagnoses, which can often be frustrating to hear as patients. As physical therapists, we treat what we see and what we can influence. Oftentimes, the symptoms are felt in the anterior part of the knee. However, the underlying contributing factors are frequently in areas away from the site of pain. If left unaddressed, the treatment outcomes are often poor.

Provocative activities: Squatting, running, stair climbing, biking, and even prolonged sitting.


Treatment:
Treatment for this condition used to focus on “VMO” strengthening, taping, and “stretching” the IT Band to decrease the load at the patellofemoral joint (think knee cap). Patient outcomes are mixed with this intervention strategy and recent studies suggest addressing areas proximal and distal to the knee may play an important role in recovery. I’m sure every runner has heard the analogy of the patella moving up and down the femur (thigh bone) and tibia (shin) like a train moving on the tracks, and the train (patella) would “jump the track” in the process, contributing to their pain. Ergo, blame was placed on the patella (train), rather than the tracks (femur/tibia) and its alignment. This also helps explain why females with an increased Q-angle (think wide hips to narrow knees) have a 45% increase in patellofemoral pressure when the knee is slightly bent! Because of the lack of randomized control trials addressing this joint, treatment needs to be geared towards strong clinical reasoning, including addressing specific hip and foot mobility issues, strength deficits, and a good movement analysis…and don’t forget the back. Grade V mobilizations can reduce knee pain and improve quadriceps muscle function!



1) Advanced Lower Extremities Workbook. The Manual Therapy Institute. PLLC 1998-2019.
2) Lack S, Barton C, Sohan O, et al. Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis
British Journal of Sports Medicine 2015;49:1365-1376.
3) Nakagawa T, Moriya E, Maciel C and Serrao F. Trunk, pelvis hip and knee kinematics, hip strength and glutealmuscle activation during a single leg squat in males and females with and without patellofemoral pain syndrome. JOSPT (2012)
4) Powers C. the influence of abnormal hip mechanics on knee injury, a biomechanical perspective. JOSPT Vol 40, no 2 42-51 (2010)
5) Souza R, Draper C, Fredericson M and Powers C. Femur rotation and patellofemoral joint kinematics: a weightbearing magnetic resonance imaging analysis. JOSPT Vol 40, no 5, 277-285 (2010)
6) Iverson CA, Sutlive TG, Crowell MS, Morrell RL, Perkins MW, Garber MB, Moore JH, Wainner RS. Lumbopelvic manipulation for the treatment of patients with patellofemoral pain syndrome: development of a clinical prediction rule. J Orthop Sports 7) Phys Ther. 2008 Jun;38(6):297-309; discussion 309-12. doi: 10.2519/jospt.2008.2669. 5Epub 2008 Jan 22. PMID: 18515959.

Check out the link below:

youtube.com/channel/UCkkTZMHS2oToDvC5_fjrPFQ/video

More to come!