Patella Femoral Syndrome

What's wrong with my knee?

It hurts when I run, and keeps hurting afterwards. Most of the pain is surrounds the patella and is variable in both intensity and location (but is clearly within the tendon) and highly dependent on activities. Eccentric loading causes the most grief, such as downhill running. The pain reached the level where it was obviously counter-productive to even contemplate running through it.

Essentially all other attributes are classical Patella Femoral Syndrome. If you're not familiar with it, a quick internet search will reveal a ridiculous amount of references, almost all giving the same descriptions.

Causes?

Hard to say exactly what the initial cause is. There is a bit of chicken or egg problems here. Best I can do is list the contributing factors that are relevant for me, then work on eliminating those problems. The list are mainly chronic issues were were probably exacerbated by some acute loading.


  • Late stage over pronation with compensatory internal rotation of tibia
  • Excessive peroneal muscle activity
  • Late and weak activation of vastus medialis oblique muscle with excessive medial shift of knee joint & femure relative to lower leg
  • Tight gluteal & TFL muscles with both reduce static & dynamic range of motion resulting excessive tightening of IT-band and lateral displacement of patella once below approxmiately 30 degrees of knee flexion
  • Tight gastrocnemius
  • Obvious strain with bruising and adhesions to vastus medialis from marathon in October
  • Inflammation of patella tendon following Eltham Fun Run at start of November

A typical list for patella femoral syndrome.


Treatment:


Three (3) stages.

STAGE 1: Acute: 1-2 weeks
The aim is to get past the initial injury responses and allow the beginning of tissue healing. I have already gone through this stage. For me it involved a massive reduction in training load, involving times of complete rest, severe restriction on running in both volume and intensity, downhill running was reduced to walking.

Icing was performed after all actvitiy, then when able to for 20 minutes every two hours until there were no signs of swelling or inflammation.

Some mild massage/physical therapy was performed on the muscle bellies of the tight muscles, in such a way not to directly affect the injured site.

Gradually some reactivation exercises were introduced for the VMO as the inflammation reduced, the exercises caused only minimal discomfort.

STAGE 2: Rehabilitation: 4-5 weeks
This is the corrective phase of training and is where I am at the moment. Here I perform a substantial amount of muscle & connective tissue manipulation to correct over tightening and imbalances. Supporting this is a strengthening program aimed at retraining the under used or weakened muscles.

Running and other activities are very gradually increased with the aim of corrective technique and running without the chronic problems that have developed over time. At this stage it includes taping of the patella to prevent the excessive lateral shift and reduce loading on the patella tendon. Usual the recommendation is the McConnell taping technique, which I am using, but at this stage I am finding it slightly inadequate. I've added a second tape line on the posterior portion of the patella tendon which seems to limit the movement enough to allow some pain free running.

This stage is completely dependant on an adequate response. I am the stage where I think it may be possible to have a go at local, mainly flat 10km race, but I will decide on the day before. So far I have been completely pain free for the last 4 days.

I still need a podiatric assessment which is coming soon to sort out shoes and orthotics. I have run in orthotics for the last 15 years, so that part won't be new. However, I had been thinking that my orthotics were no longer doing the trick before the injury showed up.

STAGE 3: Retraining: Another 6 weeks
Essentially I am back into genuine full training. The proviso will be not to make mistakes that lead to re-inury. Included in the training mix will probably be regular reassessment and corrective exercises.


Overall the injury is at least 6 weeks of directed management and will take a minimum of 12 weeks for complete healing to be assumed.

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