What is Runner’s Knee or Patellofemoral Pain? 

Patellofemoral pain is a common diagnosis seen throughout a wide age range. Pain is felt in the front, around and/or under the kneecap (patella). The pain is usually dull but symptoms may vary with each person. Patellofemoral pain refers to many different problems including patella tendinitis, patellar tracking dysfunction and chondromalacia patella, which is a softening or wearing of the cartilage under the kneecap.

Common Causes:

Patellofemoral pain may be caused by a structural defect such as abnormal foot structure and patella position. Structural deficits may contribute to abnormal mechanics when walking, running and jumping, which in turn causes stress on the knee.

Other causes include weakness in the muscles of the thigh (quadriceps) and/or tightness of the iliotibial band (outside of the thigh). If these muscles are weak, they fail to pull the kneecap up and into the groove of the thigh bone (femur).  Having a tight iliotibial band (ITB) may contribute to lateral tracking of the kneecap in the groove and cause pain. 

Other factors include poor foot support, excessive training or training that is not appropriate for that individual which causes undo stress on the kneecap.

Symptoms:

Symptoms include pain on the front, under and/or around the kneecap that may be felt with activity, after activity, or upon standing after prolonged position of the knee. People also complain about pain with stairs and squatting. Patellofemoral pain is described as a rubbing, grinding, or clicking of the kneecap.

Diagnosis

Diagnosis of this condition usually includes a thorough history and physical exam.  X-ray or MRI scanning may be recommended to rule out other conditions. 

Common Treatments 

• Non-surgical Treatment
  Non-surgical Treatment includes limiting or stopping the activities that cause the pain. Adjusting your exercise routine to limit the stress on the knee and focusing on strengthening the quadriceps and decreasing adhesions around the iliotibial band will also help improve pain. Decreasing the adhesions around the ITB will help the band slide and glide through the skin and soft tissue, therefore minimizing a lateral pull of the kneecap.  This will help maintain and improve the mechanics of the kneecap in the groove and decrease pain. In addition to strengthening, stretching of lower extremity musculature is also an important part of treatment.
  
  Using proper footwear and orthotics for your shoes will also help improve the mechanics and help decrease the pain.  Using cold packs or ice 10-20 minutes at a time and using a brace that helps maintain the kneecap in a good position may help.

• Surgical Treatment
  Surgical options are arthroscopy and realignment of the knee. Clean up and smoothing out of the cartilage to provide an even glide of the kneecap can be done, however, most patients do not need surgical intervention.