Patellofemoral (puh-tel-o-FEM-uh-rul) pain syndrome is pain at the front of your knee, around your kneecap (patella). Sometimes called “runner’s knee,” it’s more common in people who participate in sports that involve running and jumping.
The knee pain often increases when you run, walk up or downstairs, sit for long periods, or squat. Simple treatments — such as rest and ice — often help.
Patellofemoral pain syndrome usually causes dull, aching pain in the front of your knee. This pain can be aggravated when you:
- Walk up or downstairs
- Kneel or squat
- Sit with a bent knee for long periods of time
Doctors aren’t certain what causes patellofemoral pain syndrome, but it’s been associated with:
- Overuse. Running or jumping sports puts repetitive stress on your knee joint, which can cause irritation under the kneecap.
- Muscle imbalances or weaknesses. Patellofemoral pain can occur when the muscles around your hip and knee don’t keep your kneecap properly aligned. Inward movement of the knee during a squat has been found to be associated with patellofemoral pain.
- Injury. Trauma to the kneecap, such as a dislocation or fracture, has been linked to patellofemoral pain syndrome.
- Surgery. Knee surgery, particularly repair to the anterior cruciate ligament using your own patellar tendon as a graft, increases the risk of patellofemoral pain.
Symptoms of Patellofemoral Pain Syndrome
Pain in the kneecap area
Pain when moving the knee
Increasing pain when walking downstairs or down a hill
Lack of rest
Fallen arches or flat feet
Inadequate rest and recovery
Overpronation or supination of the feet
Factors that can increase your risk include:
- Age. Patellofemoral pain syndrome typically affects adolescents and young adults. Knee problems in older populations are more commonly caused by arthritis.
- Sex. Women are twice as likely as men are to develop patellofemoral pain. This may be because a woman’s wider pelvis increases the angle at which the bones in the knee joint meet.
- Certain sports. Participation in running and jumping sports can put extra stress on your knees, especially when you increase your training level.
Sometimes knee pain just happens. But certain steps may help prevent the pain.
- Maintain strength. Strong quadriceps and hip abductor muscles help keep the knee balanced during activity, but avoid deep squatting during your weight training.
- Think alignment and technique. Ask your doctor or physical therapist about flexibility and strength exercises to optimize your technique for jumping, running, and pivoting — and to help the patella track properly in its groove. Especially important is an exercise for your outer hip muscles to prevent your knee from caving inward when you squat, land from a jump or step down from a step.
- Lose excess pounds. If you’re overweight, losing weight relieves stress on your knees.
- Warm-up. Before running or another exercise, warm up with five minutes or so of light activity.
- Stretch. Promote flexibility with gentle stretching exercises.
- Increase intensity gradually. Avoid sudden changes in the intensity of your workouts.
- Practice shoe smarts. Make sure your shoes fit well and provide good shock absorption. If you have flat feet, consider shoe inserts.
To help determine the cause of your knee pain, your doctor might recommend imaging tests such as:
- X-rays. A small amount of radiation passes through your body in the process of creating X-ray images. This technique visualizes bone well, but it is less effective at viewing soft tissues.
- CT scans. These combine X-ray images from various angles to create cross-sectional images of internal structures. CT scans can visualize both bone and soft tissues, but the procedure delivers a much higher dose of radiation than do plain X-rays.
- MRI. Using radio waves and a strong magnetic field, MRIs produce detailed images of bones and soft tissues, such as the knee ligaments and cartilage. But MRIs are much more expensive than X-rays or CT scans.
- Rehabilitation exercises. …
- Supportive braces. …
- Taping. …Start the tape in line with the middle of the knee cap at the outer aspect of the knee. Using your thumb on top of the sports tape, gently push the patella towards the inner aspect of the knee whilst simultaneously using your fingers to pull the skin at the inner aspect of the knee towards the patella. Knee taping is often done to improve knee stability. It can help minimize pain and excessive range of motion during physical activity. Usually, the techniques below are used to treat issues like overuse injuries or patellofemoral problems. They can also help prevent future injuries by enhancing knee stability.
- Ice. …
- Knee-friendly sports.
Benefits of Massage for Patellofemoral Pain Syndrome (PFPS)
Myofascial release or massage therapy for clients with patellofemoral pain syndrome involves work on the muscles and soft tissues of the legs & hip. Clients are also encouraged to do suitable stretching exercises for the whole leg between sessions. Patellofemoral joint syndrome or ‘runners knee’ is also extremely common and sports massage can offer relief as it can assist in stretching shortened muscles and reducing inflammation. Rather, self-massage is a safe, therapeutic hands-on approach to self-care that can benefit your clients between sessions and their work with other health care professionals. If we follow the evidence, both massage and self-massage therapy can provide symptom relief to people suffering from osteoarthritis of the knee.
Massage works in a similar way to stretching in that it loosens the muscles – but massage offers the benefit of being able to pull the muscles and tendons into better alignment.
Types of massage that can help Runner’s Knee:
In many cases, a couple of standard massages will be enough to reduce the short-term symptoms. They will reduce muscle tension and promote better movement.
If however, the symptoms have been around for a little longer then you will need to have more detailed treatments that focus on relieving issues both higher and lower at the hips and feet.
Body Assessment – both static and functional (moving)
Trigger Point release/Dry Needling
Deep Tissue Massage/ Myofascial cupping
Myofascial release (a little gentler than Deep Tissue Massage!)
There are very few precautions to be aware of when working on the client/patient who has PFS. If stretching of the quadriceps is done, be aware that full flexion of the knee joint might be uncomfortable for the client. If adductor musculature work is done, be aware that the femoral nerve, artery, and vein are located superficial to or nearby the pectineus. And deeper work to the reticular fibers of the quadriceps femoris might not be possible if inflammation is present in the area.
Patellofemoral Pain Syndrome (Runner’s Knee) Rehabilitation Exercises
You can do the hamstring stretch right away. When the pain in your knee has decreased, you can do the quadriceps stretch and start strengthening the thigh muscles using the rest of the exercises.
Standing hamstring stretch:
Place the heel of your injured leg on a stool about 15 inches high. Keep your knee straight. Lean forward, bending at the hips until you feel a mild stretch in the back of your thigh. Make sure you do not roll your shoulders and bend at the waist when doing this or you will stretch your lower back instead of your leg. Hold the stretch for 15 to 30 seconds. Repeat 3 times.
Stand an arm’s length away from the wall with your injured leg farthest from the wall. Facing straight ahead, brace yourself by keeping one hand against the wall. With your other hand, grasp the ankle of your injured leg and pull your heel toward your buttocks. Don’t arch or twist your back. Keep your knees together. Hold this stretch for 15 to 30 seconds.
Side-lying leg lift:
Lying on your uninjured side, tighten the front thigh muscles on your top leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight and lower slowly. Do 3 sets of 10.
Sitting on the floor with your injured leg straight and your other leg bent, press the back of the knee of your injured leg against the floor by tightening the muscles on the top of your thigh. Hold this position 10 seconds. Relax. Do 3 sets of 10.
Straight leg raise:
Lie on your back with your legs straight out in front of you. Bend the knee on your uninjured side and place the foot flat on the floor. Tighten the thigh muscle of the other leg and lift it about 8 inches off the floor, keeping the thigh muscle tight throughout. Slowly lower your leg back down to the floor. Do 3 sets of 10.
Stand with the foot of your injured leg on a support (like a small step or block of wood) 3 to 5 inches high. Keep your other foot flat on the floor. Shift your weight onto your injured leg on the support straighten your knee as the other leg comes off the floor. Lower your leg back to the floor slowly. Do 3 sets of 10.
Wall squat with a ball:
Stand with your back, shoulders, and head against a wall and look straight ahead. Keep your shoulders relaxed and your feet 2 feet away from the wall and a shoulder’s width apart. Place a soccer or basketball-sized ball behind your back. Keeping your back upright, slowly squat down to a 45-degree angle. Your thighs will not yet be parallel to the floor. Hold this position for 10 seconds and then slowly slide back up the wall. Repeat 10 times. Build up to 3 sets of 10.
Wrap a piece of elastic tubing around the ankle of the uninjured leg. Tie a knot in the other end of the tubing and close it in a door.
1. Stand facing the door on the leg without tubing and bend your knee slightly, keeping your thigh muscles tight. While maintaining this position, move the leg with the tubing straight back behind you. Do 3 sets of 10.
2. Turn 90 degrees so the leg without tubing is closest to the door. Move the leg with tubing away from your body. Do 3 sets of 10.
3. Turn 90 degrees again so your back is to the door. Move the leg with tubing straight out in front of you. Do 3 sets of 10.
4. Turn your body 90 degrees again so the leg with tubing is closest to the door. Move the leg with tubing across your body. Do 3 sets of 10.
Hold onto a chair if you need help balancing. This exercise can be made even more challenging by standing on a pillow while you move the leg with tubing.
Resisted terminal knee extension:
Make a loop with a piece of elastic tubing by tying a knot in both ends. Close the knot in a door at knee height. Step into the loop with your injured leg so the tubing is around the back of your knee. Lift the other foot off the ground and hold onto a chair for balance, if needed. Bend the knee with tubing about 45 degrees. Slowly straighten your leg, keeping your thigh muscle tight as you do this. Repeat 15 times. Do 2 sets of 15. If you need an easier way to do this, stand on both legs for better support while you do the exercise.
Standing calf stretch:
Facing a wall, put your hands against the wall at about eye level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times and then switch the position of your legs and repeat the exercise 3 times. Do this exercise several times each day.
Lie on your uninjured side with your hips and knees bent and feet together. Slowly raise your top leg toward the ceiling while keeping your heels touching each other. Hold for 2 seconds and lower slowly. Do 3 sets of 10 repetitions.
Iliotibial band stretch: Side-bending:
Cross one leg in front of the other leg and lean in the opposite direction from the front leg. Reach the arm on the side of the back leg over your head while you do this. Hold this position for 15 to 30 seconds. Return to the starting position. Repeat 3 times and then switch legs and repeat the exercise.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as a diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.