I love to hear it when someone describes themselves as a “Boyle guy”. In 2012 Kevin Neeld wrote one of the most flattering pieces anyone has ever written about me: What It Means to Be a Boyle Guy I didn’t link to this so you can realize what a great guy I am, I’m linking […]
What Is Runner’s Knee – Patellofemoral Pain Syndrome?
Patellofemoral pain syndrome (PFPS), often called runner’s knee, refers to pain under and around the knee cap. The pain of PFPS may occur in one or both knees, and it tends to worsen with activity, while descending stairs and after long periods of inactivity. Patellofemoral pain syndrome is often mistaken for chondromalacia, a condition which describes damage (typically softening) of the articular cartilage on the underside of the kneecap (patella).
What Causes Patellofemoral Pain Syndrome?
While the exact cause of patellofemoral pain isn’t known, it’s believed that the way the patella tracks along the groove of the femur can lead to irritation of the cartilage on the underside of the patella. The patella can move up and down, side to side in the groove, as well as tilt and rotate. All this movement means that the patella can have contact with many of the articular surfaces of the knee depending upon a variety of factors such as muscle strength and balance, overuse, and incorrect tracking. It also means that the cause of the pain may be from a variety of different factors.
What Can You Do About Patellofemoral Pain Syndrome?
Rest is one of the first treatment steps to reduce the pain and severity of patellofemoral pain and runner’s knee. Reduce your mileage or turn to non-impact exercise, such as swimming, to keep your fitness level while allowing your knees to heal.
While many athletes can can manage their own rehab program, ideally you would want a physician or physical therapist to learn the latest treatment options and learn how to perform the exercises correctly. Depending upon your diagnosis, there may be additional strengthening and stretching exercises you will need to add to your routine.
Hip Strengthening for Patellofemoral Pain Syndrome
The latest information about patellofemoral pain syndrome points the focus on strengthening the hips to get the kneecap to track correctly. Research by the Department of Physical Therapy at Indiana University-Purdue University Indianapolis found significant reductions in kneecap pain when women runners were treated with a hip strengthening exercise program. Their study findings support the idea that kneecap motion is more influenced by the hip muscles than the quadriceps, as previously thought.
Previous research on patellofemoral pain syndrome has looked at the feet and the quadriceps as part of the problem. Some people have reported that using specific shoe insoles or strengthening the quads can reduce knee pain, and quad balance may still have a place in treatment.
Footwear and Patellofemoral Pain Syndrome
The footwear your choose, can also be an important factor in recovering from PPS. High quality shoes should be replaced every 300 to 500 miles for a runner. Shoe breakdown can result in more knee pain. Orthotics and arch supports may also be advised. Icing the knees after use, has also been shown to decrease the inflammation, and pain in the joints.
Patellofemoral pain can be hard to treat, and may take considerable time (up to six weeks) to fully recover. So ease back into an exercise routine and maintain quadriceps strength, wear appropriate footwear, and rest at any signs of overuse, and PPS is far less likely to sideline you in the future.
Here is a Hip Strengthening/Glute Activation exercise video that may help
Another exercise that has been found helpful for knee pain is the Side Plank Exercise to strengthen the hips.
Recently I posted about the importance of Foam Rolling in my article on Recovery and Regeneration. I highly suggest going to www.tptherapy.com and investing in a roller and look at some of the other products that will help you Unlock Your Body!
Below is an explanation and an image to get you going on your foam roller.
Balance on hands to work hamstrings from glute to knee
Turn toe slightly inward
Cross one foot over the other to emphasize more
Balance on elbows face down with one quad on roller
Work your way up and down from hip to top of knee
To place greater emphasis on quad bend knee
Balance on hands, roll from knee to just above ankle
Emphasize one side by crossing the leg over
Do this with toes pointed out and up
Get into side plank position with roller on one shin
Shift body to apply pressure to anterior tibialis (muscle in front of shin)
roll from knee to ankle
Rolling to outside to get emphasis on peroneus
IT bands/Vastus Lateralis–
Start in side plank position with roller in middle of the thigh
Balance on forearm and bring top leg over to place on the floor
Roll slow to find “hot spots”
Change emphasis by putting bent leg on top of other leg
Begin with roller around mid to upper back
Slowly roll to mid and upper back (shoulder blade area)
Roll right to left to emphasize one side
Lie on far side of roller on one side hip complex
Slowly roll up and down
Balance on elbow and hand with one leg on roller
Slowly roll from knee to hip complex
Regeneration using a Foam Roller
This may add longevity to an athletes career!
- Foam rolling is a form of self-massage that can be beneficial for recovery and regeneration. It may alleviate soreness and make your muscles feel better.
- A foam roller is simply a cylindrical piece of hard-celled foam.
- The roller is used to apply longer sweeping strokes to long muscles groups such as calves, quads, hamstrings and also small areas like TFL, hip rotators, and glute medius
- The foam roller can be used on a daily basis
- When an athlete is done foam rolling he/she should feel better not worse.
- Foam rolling offers a great benefit both before and after a workout or competition
- Foam rollers are a small investment to see potentially significant decrease in soft tissue, non contact injuries and offer remarkable relief.
- Obviously a hands-on massage is better than foam but this is cost effective and provides unlimited massage for less than $20.
Hydrate and re-hydrate –Why is it so vital?
- The body is 60-65% water and performs many vital functions
1.Delivery of fuel to muscles
2.Lubricate & cushion joints
3.Shock absorption for the spine & brain
- Hydration will stabilize the blood volume and prevent muscle cramping
- Consume 16 oz. of water 2 hours prior to start of activity, then ½ hour prior consume 8 oz. of fluid combined with water & carbohydrates (Gatorade)
- During exercise 4-8 oz. every 15 min
- Occurs in a very short time, especially when exercising in hot weather.
- Fluids should be consumed before, during, and after
- Easy way to determine hydration, check the color of the urine (clear-pale yellow = Hydration)
- After a long workout, it can take 24-48 hours to replace fluids lost
- The body being hydrated is an important part of foam rolling
- Tendons, ligaments, and muscles all need to slide across each other with minimal friction.
- Without adequate water the tissues cannot slide freely, over time this will lead to less and less movement and increase the chances for injury.
- In order for foam rolling to be most effective, make sure to hydrate before and after rolling
Your Recovery Plan
Have a post-exercise nutrition plan in place to consistently have recovery fuel options at your fingertips
- The ultimate goal of post-exercise refueling is to help you fully recover and prepare for the next practice or competition. Consistently consuming a mix of foods and fluids high in carbohydrates and protein (in the right amounts and at the right time) enables you to more rapidly prepare for exercise the next day. Prolonging post-exercise refueling stalls your body in a “breakdown” mode, taking it longer to recover once you do eat
- Recovery is an essential component in sports training.
- The adaptation to training occurs during the recovery.
- Recovery is the process needed for repairing damage caused by training or competition.
WARNING: Waiting a few hours after workouts and competitions to eat and drink appropriate foods and fluids with energy delays exercise recovery. While you may not feel like a large meal or a lot of solid food right after training, getting used to a small snack or liquid recovery drink can be the difference-maker for many athletes, especially during heavy training periods. Recovery nutrition is a small nutritional habit that can have a huge impact on performance
- Restore glycogen levels- to be effective carbohydrates should be taken within 2 hours after exercise.
- 1 gram of carbohydrate per kilogram of bodyweight per hour for the first two hours post exercise/post competition
- Minimize the breakdown of muscle- use a 1 to 4 ratio protein-carbohydrate
Restore depleted electrolytes- electrolyte replacement is crucial
- Sodium is the most important electrolyte as it is the one lost in sweat.
- Replacement of electrolytes can prevent heat illness, nausea, confusion, headaches, sleeplessness, post exercise fatigue, and muscle soreness.
- Avoid colas, coffee, tea, and alcohol
- Good choices- Water & sports drinks that contain sodium, foods high in water content, such as fruits, vegetables & soups
Energy System Development (Conditioning)
- ESD methods are incorporated throughout the training program.
- ESD training enables athletes to work and compete at a higher level.
- ESD is the ability to tolerate a workload and recover from that workload.
- The goal of ESD is to build a strong foundation of general fitness that has a specific transfer to the sport.
- The ability to tolerate a high workload
- The ability to recover from the workload sufficiently for the next workout
- The capacity to resist fatigue
- Fatigue – involves the nervous system and mental capacity