By Joel Lyons, PT, OCS Patellofemoral Pain Syndrome The knee continues to be the most frequently troubled area for runners. Among knee injuries, patellofemoral pain syndrome (PFPS) is the most common diagnosis for runners. Just as the name implies with this problem, pain is between the kneecap and the end of the femur. Increased friction between these two bones creates wear and tear at the joint surfaces. But the big question is “Why do we get this increased friction?” The usual answer is the repetitive nature of our sport. Then why doesn’t every runner and for that matter every walker get PFPS? Let’s look into why and I’ll present some new research that can help combat this problem. I’ve written before that abnormal structural alignment is one reason people have this problem. Increased valgus at the knee causes lateral tracking of the kneecap. Valgus knees are sometimes called “knocked-knees” and they present as the legs angle in at the knees where they are almost touching. When the quad is contracted and the person has this structure, the kneecap will be pulled laterally (toward the outside) and rub on a ridge on the femur. Since this is typically congenital we typically can’t do a lot to change this alignment. However, there are ranges in the severity of the valgus from person to person, so that it doesn’t have to be a deal breaker when it comes to running or not running. The person with increased valgus needs to be diligent with doing
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all the activities that will minimize the friction in their knees. Closely associated with this factor is increased hip adduction. This is the alignment of the hip in which the hip is at an increased acute angle instead of being closer to straight. This brings the femur inward and again can create an angle that causes more friction at the kneecap. Now this could be congenital, but it also could be created because of flexibility issues, specifically the adductor muscles of the hips. Those are the ones that we use to pull our legs together. Therefore maintaining some flexibility in this area could help reduce the effects on the knee. The splits stretch in which you simply take your legs out laterally as far as you can is helpful. You can choose to do it dynamically if you wish by standing and swinging your leg to the outside while you are standing. Swing it back in and repeat for 30 sec to a minute and do the other leg. Increased hip internal rotation has also been reported in patients with PFPS. This position has been described as “pigeontoed”, (the feet are turned inward). This might occur from the knees down, but it could happen from the hips. Again, this could be a congenital anomaly that is caused by boney alignment, but it also may be because of muscle tightness. The motion created when one lies on their back, flexes the hip and knee toward their chest, and then pulls the ankle across the midline of the body will help stretch this muscle. The other reported observation in patients with PFPS is contralateral hip drop. In this case the hip musculature is thought to be weak on the same side as the knee pain. Because of the weakness, when the person is standing only on that side, the hip is not strong enough to maintain a level pelvis. The opposite side will lower.
