Are you experiencing Runner’s Knee?
Whether you’ve been running for years, or just starting a running routine, knee pain can be a nuisance for any running progression. A common source of knee pain during running is Patellofemoral Pain Syndrome (PFPS), also known as Runner’s Knee.
Your patellofemoral joint is the joint between your kneecap (patella) and your thigh bone (femur). Your quadricep (thigh) muscle attaches to the patella from above, and contracts to pull your patella upwards and straighten your knee.
Normally, with appropriate muscular balance, the patella should smoothly glide upwards each time you straighten your knee. The inner quad (VMO) pulls the kneecap up and in, while the outer quad (VL) balances that out by pulling the kneecap up and out. What you should get here is a smooth upwards glide of the patella within the its groove. However, often times what we see is increased activity and tightness in the outer quad, along with decreased activity of the inner quad. This results in the kneecap being pulled up and outwards, leading to excessive friction between the patella and the outer portion of the femoral groove. This can lead to joint irritation and anterior knee pain.
Why would the outer quad be more active than the inner?
1) Weak hip muscles
* Less glute activation in running can lead to an inwards twisting of your knee as you place your weight through your leg (knee valgus). This can result in increased outer quad activation to stabilize the knee and counteract this knee positioning. Overtime the outer quad may become tight and exert and upwards/outwards pull on the kneecap causing friction between the outer kneecap and the underlying thigh bone
2) Flat feet
* Decreased arch strength and flat feet in running can also contribute to an inwards twist of your knee in running movements, which as mentioned, can lead to over activation of the outer quads relative to the inner quads and friction on the outer kneecap region.
3) Anterior pelvic tilt
* Prolonged sitting and tightening of our hip flexors can overtime lead to an Anterior Pelvic Tilt. This can contribute to inwards rotation of the knees and flat feet in running, leading to decreased activation of our glutes, inner quads and arch muscles and mis-tracking of the patella.
What to do?
Again, there may be a variety of reasons as to why you’re experiencing PFPS. That being said, alongside Manual Therapy in clinic to help with pelvic alignment and joint mobility, a typical plan for home may include:
1) Foam rolling the Outer Quads and IT band
2) Stretching of the Hip Flexors, Adductors and Calves
3) Strengthening the Glutes, Inner Quads and Arch muscles with an emphasis on single leg loading bearing movements