This post is all about that annoying and sometimes debilitating pain that can occur under the kneecaps or the lateral knee. This topic is close to my heart after my mother, father and brother all go under the knife to have ITB release surgery; ironically by the same Surgeon!
My father and brother were doing some distance running and my mother’s issues came about from no apparent cause. This post has nothing against the surgeon at all and the procedure they underwent was clinically indicated. But it has made me think on more than one occasion, would conservative management have spared them from the knife? It would also seem that there is a strong genetic component to patella tracking issues in the family (my grandfather has had both knees replaced by the way) so I am very interested and diligent in performing exercise and mobility that will see my own knees last the distance.
To date I have run five 250km multiday ultra marathons, two 100 km single day endurance events and 2 marathons, all within about 3 years. I have to admit my knees were not 100% during all these events, especially anything over 50km, but they have always served me quite well. In saying that, I have performed probably more strength training than any distance athlete going around and feel this may be the difference between my self and the other four family members who have battled knee pain in the past.
What is it?
Patella femoral pain is pain in the anterior knee, which is normally under the kneecap. There are a number of structures that can be the cause of the pain, like a bursa, the cartilage, inflammation of a fat pad or even bone bruising. Making things even more complicated is that the pain can also move from one place to another regularly. That being said, pain in this area is grouped together and called Patella Femoral Syndrome.
What Causes Patella Femoral Syndrome?
Often its cause is not attributed to any one factor, although many things that increase the likelihood that one presents with this condition. Some common factors include hip instability, weakness in the quadriceps musc
les, pronating of the feet, over use and individual bone structure.
Typically, some or all of these contributing factors lead to poor biomechanics and movement strategies resulting in increased lateral shear loading of the patella as it slides over the femur while walking, running and stepping.
The Vicious Cycle
If you have any sensation of patella femoral pain coming on my advice is this; NIP IT IN THE BUD.
Knee pain of this nature has the tendency to turn into a vicious cycle that can last for years. In the best case scenario, you give up the activities you love, the pain goes away and you reside to the pool for your exercise fix or in the worst case scenario, you finish on the operating table for knee replacement in your later years.
When there is ANY sort of pain present in the knee, neurological mechanisms shut down stabilising muscles like the VMO. This is well documented in the research and anyone who has had any sort of knee surgery will know how hard it is to get this muscle active. As a result there is less loading through the affected side. Less loading results in less stability and strength from the hips and glutes, which will adversely affect patella tracking leading to more pain and the cycle continues. If you believe foam rolling a sore and inflamed ITB will fix the issue, I’m afraid these strategies will have limited benefit.
What to do about it?
Patella Femoral Syndrome can be overcome with the right approach. A combination of release exercises; stretching, and strengthening exercises are all that is needed to correct the imbalances that lead to the problem.
Activity modification in the short term is recommended as a means of reducing aggravation. Taking up swimming or cycling is excellent to maintain activity levels and slow reintroduction into running should be done once symptoms subside.
In the Next Blog post, I will detail exactly what you should be doing to overcome Patella Femoral Syndrome.