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Patellofemoral Pain Syndrome

Treatments for Runner’s Knee in Asheville

Do you have pain under or around your kneecap that gets worse with running and walking (especially on the hills), going up or down stairs, or kneeling? These are classic symptoms of patellofemoral pain syndrome, an extremely common knee problem that can be very disruptive to an active patient’s life.

Patellofemoral pain is most common in adults who take part in running, cycling, or other endurance sports that involve repetitive knee-bending movements. Hence, it is commonly called “runner’s knee.” While it can be painful and stubborn, patellofemoral pain can almost always be overcome with the help of an experienced orthopedic knee specialist, and there are many treatment options to consider.

What is patellofemoral pain syndrome?

While there is no single cause, patellofemoral pain can often be linked to muscular imbalances in the thighs, hips, and gluteal muscles that cause the patella, or knee cap to track incorrectly over the space between your femur and tibia bones, called the “trochlear groove.”

In a healthy knee, smooth, slippery cartilage and fluid cover the ends of the femur, trochlear groove, and kneecap, helping the patella move smoothly and freely over the trochlear groove when you bend, jump, land or squat. Additionally, the quadriceps muscles and tendon help stabilize the femur (thigh bone) and patella during activity so that the kneecap follows the right track and these soft tissues stay healthy.

Patellofemoral pain often occurs when one or more of these features are not functioning properly and soft tissue becomes inflamed and irritated.

What are the symptoms of runners’ knee or patellofemoral pain?

  • Pain underneath or on top of the kneecap that gets worse with running, walking, or using stairs
  • Pain and stiffness after sitting for long periods
  • Crackling or popping sounds and sensations, especially upon standing

What causes patellofemoral pain syndrome?

Patellofemoral pain often occurs as an overuse injury, particularly among runners  and other athletes who place repeated strain on the knee joints. We often see patellofemoral pain in patients who have dramatically increased mileage, duration or intensity in their sport. Sometimes, the pain can be traced back to worn-out shoes or an abrupt change in surfaces (i.e., running a road marathon after training all on trails).

Another common cause of patellofemoral pain syndrome is malalignment, or incorrect tracking, of the kneecap. Instead of moving smoothly through the trochlear groove, the kneecap tracks off to one side, irritating soft tissues in the process. Malalignment can result from:

  • Weakness or strength imbalances in the hip, core, thigh and gluteal muslces, which cause the kneecap to become unstable or be “pulled” off track
  • Abnormal alignment between the hips, legs, and ankles, which cause the kneecap to shift inward or outward, or situate too high in the trochlear groove (patella alta).

How can patellofemoral pain be treated?

If you are experiencing mild patellofemoral pain, you might benefit from at-home treatments. Activity modification, icing the knee several times per day, and taking over-the-counter anti-inflammatory drugs such as Advil or Aleve short-term—do not take anti-inflammatory drugs for extended periods without a doctor’s supervision—can help.

Complete rest is usually not necessary; avoid activities that worsen your knee pain and try low-impact alternatives. Swimming or cycling can be good alternatives to running.

Treatments for runner’s knee and patellofemoral pain

If at-home treatments are not effective, our knee specialists at Carolina Hand & Sports Medicine can help. We’ll take time to identify the underlying cause of injury, treat symptoms to relieve your pain, and help you make long-lasting changes to prevent patellofemoral pain from returning. Steps of treatment include:

  • physical examination to diagnose patellofemoral pain syndrome and determine a treatment plan
  • X-rays or other imaging tests to rule out other possible problems contributing to your pain
  • A personalized treatment plan. Physical therapy, orthotics, platelet therapy, or surgery may be recommended.

Surgery to treat patellofemoral pain

If patellofemoral pain syndrome is very severe or preventing you from leading a normal life, and non-surgical treatments have not been successful, surgery may be the next step.  Possible knee surgery procedures we may recommend include:

  • Arthroscopic Debridement. Using a tiny camera and thin instruments, an orthopedic surgeon can remove damaged cartilage from the knee to relieve pain.
  • Arthroscopic Lateral Release. If incorrect knee tracking is caused by a tight lateral retinaculum tendon (a small tendon on the outside of the knee), this tendon can be released to allow the kneecap to track properly.
  • Tibial Tubercle Transfer. This is a more extensive procedure in which the patellar tendon and a small portion of the tibial bone are shifted over slightly toward the inside of the knee to allow for better kneecap tracking.

Are you tired of suffering from runner’s knee? Let our Asheville sports medicine doctors help you (and your knee) get back on track. Contact us today to schedule an appointment.

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