Rehabilitation Strategies for Runner’s Knee: A Physiotherapy Approach to Patellofemoral Pain Syndrome

Introduction Runner’s knee, clinically known as Patellofemoral Pain Syndrome (PFPS), is a common overuse injury affecting runners and athletes. It is characterized by anterior knee pain, often exacerbated by activities such as running, squatting, and stair climbing. Physiotherapy plays a crucial role in managing and rehabilitating PFPS through targeted interventions that address the underlying biomechanical and muscular imbalances.

Clinical Scenario: Addressing Runner’s Knee at Constant Co Fitness and Rehab Center, Kuala Lumpur A 35-year-old recreational runner, Mr. Adam, visited our clinic, Constant Co Fitness and Rehab Center in Mont Kiara, Kuala Lumpur, with complaints of persistent knee pain for the past three months. He reported discomfort during running, prolonged sitting, and descending stairs. A physical examination revealed weak quadriceps, tight iliotibial bands, and poor hip stability—common contributing factors to PFPS.

Assessment and Diagnosis A comprehensive physiotherapy assessment was conducted, including:

• Postural and gait analysis: Revealed excessive foot pronation and increased dynamic knee valgus.
• Muscle strength testing: Showed quadriceps and gluteus medius weakness.
• Flexibility assessment: Indicated tightness in the iliotibial band (ITB), hamstrings, and gastrocnemius muscles.
• Patellar tracking evaluation: Identified lateral patellar maltracking.

Based on these findings, Mr. Adam was diagnosed with PFPS, and an individualized rehabilitation program was developed.

Rehabilitation Strategies

1. Pain Management and Initial Rest

• Activity modification: Reduced high-impact activities such as running and replaced them with low-impact alternatives (cycling, swimming).
• Cryotherapy (Ice application): Recommended post-exercise to reduce inflammation.
• Taping techniques (McConnell or Kinesio taping): Provided to correct patellar tracking and relieve pain (Callaghan & Selfe, 2012).

1. Strengthening Exercises

Quadriceps strengthening: Emphasizing the vastus medialis obliquus (VMO) with exercises such as:

• Isometric quadriceps contractions
• Straight leg raises
• Terminal knee extensions

Hip stabilizer strengthening

• Side-lying hip abductions
• Clamshell exercises
• Resistance band lateral walks

2. Stretching and Soft Tissue Mobilization

• Iliotibial band and lateral structures: Foam rolling and ITB stretching.
• Hamstring and gastrocnemius muscles: Dynamic and static stretching to improve flexibility.
• Manual therapy: Soft tissue release and myofascial techniques to address tight structures (Ferber et al., 2015).

3. Biomechanical Correction and Movement Retraining

• Gait retraining: Encouraging a midfoot strike pattern and increasing cadence to reduce patellofemoral joint stress (Lenhart et al., 2014).
• Footwear assessment: Recommended proper running shoes and, if needed, orthotics for arch support.
• Proprioceptive training: Balance exercises using BOSU balls and single-leg stance drills.

4. Gradual Return to Running

• Implemented a structured return-to-running program, gradually increasing intensity and volume.
• Incorporated strength training alongside running to prevent recurrence.
• Educated the patient on self-management strategies and injury prevention.

Outcome and Follow-Up After eight weeks of rehabilitation, Mr. Adam reported significant pain reduction, improved quadriceps and hip strength, and better running mechanics. A follow-up assessment showed normalized patellar tracking and enhanced lower limb stability. He successfully resumed his running routine with a modified training plan and continued strength maintenance exercises.

Conclusion Physiotherapy plays a vital role in rehabilitating Runner’s Knee through a structured approach addressing pain, muscle imbalances, biomechanics, and movement retraining. By integrating evidence-based interventions, physiotherapists can help patients recover effectively and prevent recurrence. Continuous research and patient education remain essential components of managing PFPS.

References

• Callaghan, M. J., & Selfe, J. (2012). "Patellar taping for patellofemoral pain syndrome in adults." The Cochrane Database of Systematic Reviews.
• Ferber, R., Noehren, B., Hamill, J., & Davis, I. M. (2015). "Competitive runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics." Journal of Orthopaedic & Sports Physical Therapy.
• Lenhart, R. L., Thelen, D. G., Wille, C. M., & Chumanov, E. S. (2014). "Increasing running step rate reduces patellofemoral joint forces." Medicine and Science in Sports and Exercise.
• Willy, R. W., & Davis, I. S. (2011). "The effect of a hip-strengthening program on mechanics during running and during a single-leg squat." Journal of Orthopaedic & Sports Physical Therapy.