Physiotherapy for 3 common knee injuries in runners

Patellofemoral pain syndrome

Patellofemoral pain syndrome (PTPS) is the most common knee injury we see in runners. People with PTPS will feel pain at the front of the knee and patients often complain that they experience pain the moment they start running.

One of the biggest causes of PTPS is a muscle imbalance. The imbalance could be because of a previous injury that wasn’t rehabbed properly, or due to muscle atrophy. The way that a person runs can also cause patellofemoral pain, for example if they have a hip drop. PTPS can also be because of a structural issue: Runners with flat feet often experience this injury.

We use a combination of the following to treat PTPS:

• Dry needling
• Manual therapy (soft tissue manipulation)
• Laser therapy to improve blood flow in the area
• Strapping
• Rehabilitation exercises to decrease pain and improve function

We focus on the muscles around both the knee and hip when treating PFPS, so a patient’s rehab exercises will include exercises to strengthen the muscles in both areas. We often refer patients with flat feet to get orthotics (inner soles) fitted in their running shoes.

Once a patient is pain-free, the physio will look at how they run to see if their technique needs changing. Runners with a hip drop, for example, cause high impact on the knee. Those with a very long stride, who land flat-footed (rather than on the forefront of the foot) cause high impact on the hip which affects the knee on the same leg. Your physio will help to adjust your running technique to prevent further injury.

There are different types of PFPS, and length of recovery depends on which condition the patient has. However, in general it takes about 3 months to recover, provided the patient has been following their rehab programme religiously.

Iliotibial band friction syndrome

Patients with iliotibial band friction syndrome (ITBFS) normally feel pain on the outer side of the knee or thigh. Those with ITBFS may also have a muscle imbalance and weakness around the knee and hip. Overuse is one of the main causes of an ITBFS injury. People who have suddenly started running hills or increased their kilometres too quickly may get an ITBFS injury.

Because blood supply to the iliotibial area is poor, we try to increase blood supply during treatment to reduce inflammation and pain.

We use the following treatments for ITBFS:

• Manual therapy
• Dry needling
• Stretches

We also ask our patients to use a foam roller on that side of their leg as part of their ‘at-home’ rehabilitation.

Patients who receive treatment for ITBFS almost immediately can recover within 2 – 3 weeks. However, if it’s left too long it can take between 3 and 6 months to recover.

Patellar tendinopathy

Patellar tendinopathy (PT) causes pain at the front of the knee, under the knee cap. Our patients with PT usually feel stiffness in the knee when they stand up after sitting for a while.

PT, like ITBFS, is an overuse injury. For example, if a runner suddenly decides to do a marathon in six weeks’ time they may increase their training distances too quickly, causing injury.

To treat PT, we do the following:

• Manual therapy
• Strapping
• Ice
• Dry needling
• Stretches

It takes between 3 and 6 months to recover from PT. If PT is left untreated, the person will always have knee pain when they run.

When should you visit a physio?

A physiotherapist is the first in line when it comes to conservative treatment for knee injuries. You might opt to visit the physio yourself or you could be referred to one by your doctor or an orthopaedic specialist.

Physiotherapists treat runners of all ages who struggle with these injuries. We urge people not to continue running if they have pain, because this causes muscle inhibition which can leads to longer term problems for the patient. It is also important to treat inflammation in younger patients as soon as possible, to decrease damage to the joint, and minimise their chances to getting osteoarthritis.

Treatment sessions at a physio are typically around 45 minutes long. Patients normally leave the session with less pain. Some will have strapping placed and most will be given exercises to do at home until it’s time to come for their next appointment. It is important that patients follow their ‘homework’ to ensure the quickest possible recovery time.

If we don’t see any improvement in patients after six weeks of treatment, we will try a different treatment approach or refer the patient to an orthopaedic surgeon. We refer runners who need to reach the same level of performance that they were at before their injury to a biokineticist for final rehab. We only do this once the patient no longer experiences pain.

Finally, we urge all runners to get professionally fitted for the correct shoes to prevent unnecessary injuries.