Runner’s Knee – Whats and What Nots Part 3/3

Runner’s Knee Part 1
Runner’s Knee Part 2
Runner’s Knee Part 3
Runner’s Knee Recap

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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.

2. Biomechanical Correction:foot-strength
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.

 

3. 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.

 

4. Tissue Flexibility
cpc-dem-0078-1
Tension in the Hamstrings, Calf and Quad muscles can increase forces on the Knee [20] and reducing this tension may help reduce pain.  ‘Tightness’ is what we feel when a muscle is overly tensioned.  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.

 

5. 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.

 

6. Other:
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 approach is a matter for debate in recent years, so 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:  This is also a topic for a future article, as there is far too much to discuss in the research to be able to do it justice here.

 

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.

 

 

*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.

 

 

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://www.zerenpt.com/uploads/6/2/6/8/6268971/2058308_orig.jpg
  2. http://www.drnicksrunningblog.com/wp-content/uploads/2015/12/img_0133.jpeg
  3. https://www.youtube.com/watch?v=1Vk6bueduNc
  4. http://www.sportsister.com/wp-content/uploads2/cpc-dem-0078-1.jpg
  5. http://www.zerenpt.com/blog/-free-return-to-running-program-for-injured-runners
  6. http://www.thesportsphysiotherapist.com/wp-content/uploads/2010/09/fig10-9.jpg
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Ruairi O'Donohoe Physiotherapy

Chartered Physiotherapist based in Dublin City centre.

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