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Runner’s Knee Part 3

RUNNER’S KNEE

The Whats and What Nots!

Part 3 / 3

marathon2

PART 3: REHABILITATION

Recovery time varies per individual and their adherence to their rehabilitation.  Education of your specific condition is key to recovering from and preventing recurrence of PFPS.

 

  1. Dynamic Rest:

A rest period is important to quickly reduce the pain and for quicker recovery.  During this period, you can still run but at a reduced intensity, so as to remain pain free.  If you cannot run pain free, substitute your activity with other forms of pain free exercise to maintain your fitness (cycling, swimming) until you can return pain free.  Modify your daily activities as needed to prevent pain, such as bending, squatting, stairs, slopes.

 

  1. Biomechanical Correction:

As previously seen, there are many factors that can lead to PFPS, so a blanket treatment plan would not be effective.  After identifying the underlying Biomechanical problem for your PFPS, a treatment plan can be devised.

 

holding knee

  1. Hip and Quad Strengthening

Strong Muscles act as effective shock absorbers 18, and so can reduce the force experienced by the joints on impact.  Hip strengthening 19 and Quad strengthening Exercises have been shown to be very effective for the correction of PFPS.   The Step Up Exercise is very good for developing control and stability of the Hip and Knee.

 

  1. Tissue Flexibility

Tension in the Hamstrings, Calf and Quad muscles can increase forces on the Knee 20 and reducing this tension may help reduce pain.  Soft tissue techniques such as massage, stretching or Foam Rolling may help relieve this tension.  ‘Tightness’ is what we feel when a muscle is overly tense.  However, this tension is often present to compensate for a lack of stability elsewhere.  Removing this tension without addressing the underlying stability issue will likely result in the same tightness returning.  This is why it is very common for athletes to regularly need to stretch or foam roll.

 

  1. Return to Running

It is important to gradually return to running in order to ensure a relapse in your condition does not occur.  Chris Johnson of Zeren PT provides a very helpful Return to Running Program to allow a safe and effective return to activity.  Care should be taken to gradually gradually increase mileage and to take smaller strides especially on hills.

 

  1. Other:

R_I_C_E

RICE:  Rest, Ice, Compress, Elevate.  Conventional wisdom has always advised the use of R.I.C.E. for the treatment of acute injuries and pains.  However this has come under debate in the recent years, and this is a topic for another article.  For now, do what has always worked for you.

 

Tape/Braces/Orthotics:  These should be considered Short Term Options to assist you during your rehabilitation.  Taping has been shown to be effective regardless of the type of technique or tape used.  Improvements are unlikely due to the repositioning of a joint, but may actually come from the stimulation of the skin of the affected area.21  Due to this, a nonspecific ‘incorrect’ taping may provide as effective relief as a specifically tailored ‘correct’ taping.  This effect may be similar for bracing or supports.  Orthotics or Arch Supports may prevent the arch from falling, but they will not resolve the reason why the arch is falling.  Over the counter orthotics can provide effective relief, similar even to custom made orthotics.22

 

Running Technique:  There is a lot of debate about running technique and there is too much information to cover in this article.

REHABILITATION SUMMARY:

  • Modify your activity to become pain free.
  • Identify and address your underlying Biomechanical fault.
  • Hip and Quads strengthening exercises are beneficial.
  • Reduce muscle tension to help relieve pain. Find underlying cause of this tension.
  • Return to Running Gradually.
  • Use R.I.C.E., Tape, Braces or orthotics to assist in your Rehabilitation.

 

REFERENCES

  1. http://www.ncbi.nlm.nih.gov/pubmed/24465673
  2. http://www.ncbi.nlm.nih.gov/pubmed/26039034
  3. http://www.aafp.org/afp/1999/1101/p2012.html
  4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1323297/
  5. http://www.ncbi.nlm.nih.gov/pubmed/1897659

 

RESOURCES/IMAGES

  1. http://runnersfeed.com/wp-content/uploads/2012/01/camp.jpg
  2. http://fitnessrepublic.com/wp-content/uploads/2013/04/quad-strengthening-exercises-for-bad-knees-img-16942.jpg
  3. https://www.youtube.com/watch?v=1Vk6bueduNc
  4. http://www.zerenpt.com/blog/-free-return-to-running-program-for-injured-runners
  5. http://1.bp.blogspot.com/_BLNJ9sVWDjc/TNcZoPBj4tI/AAAAAAAAAEw/Yiuf-W0tLMI/s320/RICE.jpg
  6. http://www.thesportsphysiotherapist.com/wp-content/uploads/2010/09/fig10-9.jpg

 

*Any questions, comments regarding the content of this article are highly welcome.  You contact me on ruairiodonohoe.physio@gmail.com to discuss.

 

**This article is meant for educational purposes only and should not be used for diagnosis or treatment, and should never replace any advice given to you by your rehabilitation professional.  Knee pain can occur for a variety of reasons, so it is important to visit a Physiotherapist to ensure you are accurately assessed so the source of your pain can be identified and treated correctly.

 

***If any content of this article belongs to you and requires permission for use, I apologise and please contact me so I can replace it.

 

 

Ruari o Donohoe| Complete Fitness| Dublin 2

Email: ruairiodonohoe.physio@gmail.com

Tel: 0874676955

 

 

 

REFERENCES

  1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1402378/
  2. http://www.uptodate.com/contents/overview-of-running-injuries-of-the-lower-extremity
  3. http://www.uptodate.com/contents/overview-of-running-injuries-of-the-lower-extremity
  4. http://www.ncbi.nlm.nih.gov/pubmed/17545417
  5. http://www.ncbi.nlm.nih.gov/pubmed/24113699
  6. http://www.ncbi.nlm.nih.gov/pubmed/9850777
  7. http://www.ncbi.nlm.nih.gov/pubmed/9784819
  8. http://www.ncbi.nlm.nih.gov/pubmed/4017335
  9. http://www.ncbi.nlm.nih.gov/pubmed/17142409
  10. http://www.ncbi.nlm.nih.gov/pubmed/19090000
  11. http://www.ncbi.nlm.nih.gov/pubmed/19212898
  12. http://www.ncbi.nlm.nih.gov/pubmed/18452611
  13. http://www.ncbi.nlm.nih.gov/pubmed/6712434
  14. https://www.ncbi.nlm.nih.gov/pubmed/24766358
  15. http://www.ncbi.nlm.nih.gov/pubmed/19098153
  16. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435911/
  17. http://www.ncbi.nlm.nih.gov/pubmed/19098153
  18. http://www.ncbi.nlm.nih.gov/pubmed/24465673
  19. http://www.ncbi.nlm.nih.gov/pubmed/26039034
  20. http://www.aafp.org/afp/1999/1101/p2012.html
  21. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1323297/
  22. http://www.ncbi.nlm.nih.gov/pubmed/1897659

 

RESOURCES/IMAGES

  1. http://world-running.s3.amazonaws.com/production/uploads/articles/1862c7e1626de540e4487ca4923423f94e55/large.jpg
  2. http://www.runnersworld.com/running-tips/how-to-achieve-a-runners-high
  3. http://www.stopthoughtviruses.com/2015/04/knee-pain-and-running-getpt1st.html
  4. https://www.painscience.com/imgs/pfps-graphic-definition-l.png
  5. http://pilateswellness.net/wp-content/uploads/2015/09/_d_improd_/treat-root-cause_f_improf_600x600.png
  6. https://pbs.twimg.com/media/CAIBNsVWcAAWM69.jpg
  7. http://www.stopthoughtviruses.com/p/what-is-thought-virus.html
  8. http://www.epainassist.com/images/surgery-for-chondromalacia-patella.jpg
  9. http://www.yoursurgery.com/procedures/arthroscopy/images/Rough_patella.jpg
  10. http://www.bodyheal.com.au/image/data/patellar-tracking-disorder.jpg
  11. http://www.knee-pain-explained.com/images/Illu_lower_extremity_muscles250VMO.jpg
  12. https://www.yogatuneup.com/blog/wp-content/uploads/2013/12/Q_angle.jpg
  13. http://erikdalton.com/images/LegLengths.jpg
  14. https://bretcontreras.com/wp-content/uploads/Capture32.jpg
  15. http://ajs.sagepub.com/content/26/5/715/F10.large.jpg
  16. http://www.foundationpilates.com/wp-content/uploads/2014/05/LPH-Complex.jpg
  17. http://denverfitnessjournal.com/wp-content/uploads/2013/08/Trendelenburg1.jpg
  18. http://3.bp.blogspot.com/_dFl4Jw0XEQs/SwJ6f_j34kI/AAAAAAAAAA4/QNWOhsHIisk/s1600/GRF.jpg
  19. http://fixflatfeet.com/wp-content/uploads/2013/03/Pronation-Effects.jpg
  20. https://www.youtube.com/watch?v=AdB3IwnLgiw
  21. https://www.youtube.com/watch?v=1Vk6bueduNc
  22. http://www.zerenpt.com/blog/-free-return-to-running-program-for-injured-runners
  23. http://www.thesportsphysiotherapist.com/wp-content/uploads/2010/09/fig10-9.jpg

 

About the Author Marc Smith