What Runners Need to Know (by Joel Lyons

By Joel Lyons, PT, OCS

Patellofemoral Pain Syndrome all the activities that will minimize the friction in their knees.

The knee continues to be the most frequently Closely associated with this factor is increased troubled area for runners. Among knee injuries, hip adduction. This is the alignment of the hip in patellofemoral pain syndrome (PFPS) is the most which the hip is at an increased acute angle instead common diagnosis for runners. Just as the name of being closer to straight. This brings the femur implies with this problem, pain is between the kneecap inward and again can create an angle that causes and the end of the femur. Increased friction between more friction at the kneecap. Now this could be these two bones creates wear and tear at the joint congenital, but it also could be created because of surfaces. But the big question is “Why do we get this flexibility issues, specifically the adductor muscles increased friction?” The usual answer is the repetitive of the hips. Those are the ones that we use to pull our nature of our sport. Then why doesn’t every runner legs together. Therefore maintaining some flexibility and for that matter every walker get PFPS? Let’s look in this area could help reduce the effects on the knee. into why and I’ll present some new research that can The splits stretch in which you simply take your legs help combat this problem. out laterally as far as you can is helpful. You can

I’ve written before that abnormal structural choose to do it dynamically if you wish by standing alignment is one reason people have this problem. and swinging your leg to the outside while you are Increased valgus at the standing. Swing it back in and repeat for 30 knee causes lateral tracking sec to a minute and do the other leg. of the kneecap. Valgus Increased hip internal rotation has also knees are sometimes called been reported in patients with PFPS. This “knocked-knees” and they position has been described as “pigeonpresent as the legs angle in toed”, (the feet are turned inward). This at the knees where they are might occur from the knees down, but it almost touching. When the could happen from the hips. Again, this quad is contracted and the could be a congenital anomaly that is caused person has this structure, by boney alignment, but it also may be the kneecap will be pulled because of muscle tightness. The motion laterally (toward the outside) created when one lies on their back, flexes and rub on a ridge on the the hip and knee toward their chest, and femur. Since this is typically then pulls the ankle across the midline of the congenital we typically body will help stretch this muscle. can’t do a lot to change this The other reported observation in alignment. However, there patients with PFPS is contralateral hip drop. are ranges in the severity In this case the hip musculature is thought to of the valgus from person be weak on the same side as the knee pain. to person, so that it doesn’t have to be a deal breaker Because of the weakness, when the person is standing when it comes to running or not running. The person only on that side, the hip is not strong enough to with increased valgus needs to be diligent with doing maintain a level pelvis. The opposite side will lower. 16