How To Fix Runner’s Knee Pain – WITHOUT Surgery!
Knee pain keeping you sidelined?
Patellofemoral pain syndrome (PFPS), also called runner’s knee or simply anterior knee pain, is by far the most common type of knee pain I treat as a chiropractor in Brookfield, WI. And it can be a giant pain in the, well, knee.
Almost anyone can get it, but it particularly affects runners, with a prevalence of 19-30% in female runners and 13-25% in male runners, according to one recent review. It’s also a common cycling inury – almost 40% of pro cyclists deal with it.
But simply calling it runner’s knee leaves out the droves of office workers and anyone who sits for a living that suffers from PFPS, as the structures supporting the kneecap can actually be fatigued by a constantly flexed knee. PFPS is also surprisingly frequently seen in teenagers.
Basically, no one’s safe from it. But it’s usually fixable!
Some people recover from PFPS by simply taking time off to rest and then slowly working their way back to normal activity, but not everyone. Anterior knee pain can be extremely difficult to treat, and often becomes a chronic problem that can be just as debilitating as more serious breakdowns.
What kind of ‘runner’s knee’ do you have?
The main symptom of PFPS is pain under and around the kneecap that’s generally mild at first but often becomes progressively more intense and increasingly present if not properly addressed. One or both knees can be affected.
It’s different than IT band syndrome – the other kind of runner’s knee – which usually causes pain on the outer side of the knee, above the lateral epicondyle. IT band syndrome is also usually worse going down hills or stairs, while patellofemoral pain is usually worse going up stairs or hills.
Patellofemoral pain is also distinctly different from more severe injuries to the ligaments and meniscal cartilage of the knee. If you have any of these symptoms, you can be relatively sure it’s not PFPS:
• Locking or clunking usually indicates trouble with the meniscus.
• Sudden onset of symptoms usually indicates a traumatic injury to the soft tissues. Runner’s knee can get intense fast — as quickly as a few minutes — but not suddenly with a surge of pain.
• Throbbing pain in the back of the knee is usually a different issue.
• Tingling or numbness aren’t signs of runner’s knee.
Where is the pain coming from?
In a normal knee, your patella (or kneecap) glides smoothly up and down in a groove created by V-shaped notches in your femur (thigh bone) and tibia (the larger bone in your lower leg). And as the knee flexes and extends, the kneecap does a little dance as it slides, rotating and tilting and deviating. This motion is what’s referred to as patellar tracking.
If the kneecap tracks incorrectly in this groove (usually to the lateral/outer side of the knee), it causes inflammation of the cartilage and soft tissue beneath it. Though you can quite easily have a tracking issue without knee pain, and knee pain without a tracking issue, abnormal patellar tracking is the usual suspect in patellofemoral pain syndrome.
In fact, they’re so closely associated that the terms patellofemoral pain syndrome and patellofemoral tracking syndrome are often used interchangably.
Conventional thinking has been to blame muscle imbalances between the four quadricep muscles that attach to the top of the kneecap. Countless patients who walk into Ascent Chiropractic with anterior knee pain have been told it’s due to greater strength and stiffness in the outer quads (the vastus lateralus) compared to the inner quads (the vastus medialis/VMO), causing the kneecap to to shift to the outside.
Even the American Family Physician journal confidently declared the cause of PFPS in a tutorial for physicians published in 2007:
“[Patellofemoral pain syndrome] is caused by imbalances in the forces controlling patellar tracking during knee flexion and extension, particularly with overloading of the joint.”
This simplistic way of thinking is why so many physiotherapists and athletic trainers just prescribe exercises to strengthen the medial quads to try to pull the kneecap back to the center. It’s why orthopods prescribe knee braces and straps (which no nothing but jam the kneecap harder into the groove, exacerbating the injury) and send patients on their way.
It’s also why surgeons will cut up the outside of the knee or move tendon attachment points to try to reduce the pull on the outer side of the patella. These procedures are what are known as lateral release and tibial tubercle transfer surgeries, and they usually do nothing other than to create a bunch of scar tissue in the knee.
If you’re thinking only about muscle balance these approaches might make sense. But in reality, they’re all treating the effects instead of addressing the root biomechanical problem.
Conventional thinking on PFPS is wrong
Warning: this is about to get a little nerdy. If you dig a little deeper into the biomechanics of all this, you’ll see that a lack of quadricep muscular control is not really what’s causing abnormal patellar tracking.
The real problem? Misalignment of those V-shaped patellar grooves in the femur and tibia we talked about before. Specifically, the femur shifting and rotating inwards (also known as femoral adduction and anteversion) and the tibia rotating outward (also known as external tibial torsion).
Now here’s where what we do at Ascent Chiropractic comes in: this entire biomechanical chain is controlled by the alignment of your pelvis, hips, knees, ankles and feet. That’s what we fix.
Femur anteversion/adduction causes an increased Q angle – or how far your hip and knee angle inward. This is the reason it can appear that your kneecap is shifted to the outside when it’s acutally the groove underneath shifting inward.
When your pelvis tilts forward or laterally, it causes your femur to rotate inwards and increases your Q angle. It also explains why women (who naturally have a more anteriorly-tilted pelvis and bigger Q angle) are more than twice as likely to suffer from PFPS as men.
To compensate for your femur rotating and shifting inward, your tibia will rotate the opposite way – outward. Studies have shown this can also happen independently of anything going on in your hip and pelvis if the medial arch in your foot is collapsing and your ankle is rolling inward.
Normal Q angle (A) and increased Q angle (B) causing lateral patellar tracking
The Fix For Patellofemoral Pain Syndrome
Research has shown that PFPS sufferers tend to have hip and pelvic joint dysfunction and be weak in certain important pelvic stabilizing muscles – in particular, the hip abductors and external rotators. They also tend to have weak arches and ankles.
Fortunately, all of these issues are fixable.
1.) Reduce pain and inflammation.
Rest and ice are good first steps for reducing inflammation. Isometric muscle contractions can effectively reduce pain through an effect known as descending analgesia. Try this: Lie on your back with a rolled towel positioned underneath the affected knee. Contract your quadriceps and try to press the towel into the floor with the back of your knee. Hold the contraction for 5-10 seconds and relax. Repeat 10 times.
2.) Correct biomechanical dysfunction.
It’s difficult to identify exactly what needs to happen biomechanically to get anterior pelvic tilt, femoral anteversion, and external tibial torsion corrected without the help of a chiropractor or other professional.
Any treatment plan will need to be customized to specifically address what’s going on in your body – and that can mean correcting joint dysfunction and soft tissue problems in your pelvis, hips, knees, ankles feet.
Full-length custom flexible orthotics – we highly recommend Foot Levelers – prevent medial arch collapse, over-pronation, and internal tibial torsion. Every patient requires different levels of support, so these need to be custom-made.
3.) Strengthen the hip external rotators and abductors.
The solution to weak pelvic stabilizing muscles is, of course, strength training the muscles in your butt. Here are two exercises to try:
Standing Side Leg Lift (for hip abductors): Loop a resistance band around just above the knees and stand with your feet about 10 inches apart. Shift your weight to your left foot and raise your right leg to the side as far as possible. Slowly return to the starting position. Repeat 10 times, switch to the left leg, and repeat.
Open Glute Bridge (for external rotators): Loop a resistance band around your legs just above the knees and lie on your back with your knees sharply bent and your feet flat on the floor about 10 inches apart. Now lift your butt off the ground, push your hips forward and pull your knees apart to stretch the band as far as you can. Hold this position for five seconds, then relax. Repeat 10 times.
The Ascent Chiropractic Difference
There’s a reason so many patients choose us as their chiropractor – we’re experts in the biomechanics of everything from your head to your toes, and we combine the best of both chiropractic and myofascial rehabilitative therapy treatments. So if you’ve been self-diagnosing, living in the pharmacy aisle, or dismissed by doctors, trainers and therapists who aren’t interested in actually figuring out what the problem is, it’s time to get the answers you deserve and get out of knee pain for good.
Looking for a Brookfield Chiropractor and ready to get started?
Make an appointment at Ascent Chiropractic by calling 262-345-4166 or using our online scheduling app.
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