Patellofemoral Pain Syndrome & Treating Runners
As the temperature outside continues to rise, more and more people will go outdoors for hikes and runs. This also means more patients with patellofemoral pain syndrome will walk through the clinic doors. Let’s step into some rehab exercises and some running gait considerations for treating patellofemoral pain in runners.
Patellofemoral Pain Syndrome Exercises
There are various exercises to load the knees and the hips. Previously, the aim of rehab was to strengthen the VMO muscle, which was thought to have a role in patellar tracking. However, research has found that strength and contraction timings of the VMO are inconsistent in those with patellofemoral pain. (1) Therefore, the key to rehab is finding a tolerated load and gradually transitioning back to running.
Keep it simple by strengthening the entire quad/glute and not just the VMO.
Wall Sit
Besides building strength around the knee, rehab exercises should also focus on building tolerance to compression with knee flexion. Beginning with a wall sit allows the most control of the knee range of motion. Initially, start with the knee more extended and gradually load more into knee flexion as tolerated.
Seated Knee Extension
These can be progressed to isotonic exercises like a seated knee extension. Depending on the access to equipment, either doing these at home with an exercise band or at the gym on the knee extension machine are viable options.
Reverse Lunge
The final progression is to increase the load and the compression with a lunge progression. A reverse lunge allows the tibia to remain vertical, which reduces the compression at the patellofemoral joint. However, progressing to a forward lunge, gradually taking smaller and smaller steps, will help build a tolerance to increased compression at the joint.
For the gluteals, the goal is strengthening the hip both as an extender and abductor.
The Glute Bridge
The glute bridge is a simple exercise for hip extension. For those who may have difficulty feeling the glutes engage, dropping the knees a little out can better align with the orientation of the femoroacetabular joint. Then, progress the challenge of the exercise by performing a single-leg glute bridge aiming to keep the hips parallel to the ground.
Side-Lying Hip Raise
For hip abduction, a side-lying hip raise is a modification of the side bridge that can be a useful starting place. Ensure that the knees are bent to roll over the shin; otherwise, it might increase the stress on the bottom knee. These can then be progressed to something more challenging, like a banded lateral step.
Check out this webinar on hip abductor weakness to learn more.
Interestingly, strengthening the hip abductors like the glute medius was thought to help control the hip adduction and hip internal rotation of the femur and knee valgus during running. However, a study found that a hip-strengthening program did not alter the running biomechanics, specifically looking at femoral internal rotation. (2) So, strengthening alone might not be sufficient to modify the biomechanics of the knee with internal rotation.
Modifying Running Cadence for Patellofemoral Pain Relief
This is where modifying the running cadence can benefit those with patellofemoral pain. And there are two reasons why modifying the running cadence can be helpful in this population.
The first is increasing the running cadence by 10% of normal, resulting in decreased contralateral pelvic drop and hip abduction at 1-month and 3-month follow-ups. (3)
💡 Clinical tip: In the Apple Fitness app, the average cadence is calculated for the workout.
Additionally, increasing the running cadence by 10% reduces the peak patellofemoral loads during running by 14%. (4) This is especially important in more novice runners who tend to run with a slower cadence.
ChiroUp subscribers can check out these running infographics in the Forms Library.
So, changing the running cadence not only alters running biomechanics but also reduces the load on the patellofemoral joint, which can be helpful in a rehab program for patellofemoral pain syndrome.
There are several ways to help runners increase their running cadence. The first is using a metronome app set to whatever the desired cadence is. This is definitely the least exciting option. Another option is looking for a song with a similar BPM to the desired running cadence. Just be sure that if someone is running with headphones, they have them on transparency mode to hear traffic and other safety concerns around them!
For a comprehensive approach to understanding and effectively treating patellofemoral pain syndrome, check out ChiroUp. ChiroUp offers a complete treatment plan not only for PFPS but also for over 150 other conditions. Sign up now for FREE.
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Powers, Christopher M., et al. "Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3." British journal of sports medicine 51.24 (2017): 1713-1723.
The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat
Bramah C, Preece SJ, Gill N, Herrington L. A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months. Am J Sports Med. 2019 Dec;47(14):3406-3413. doi: 10.1177/0363546519879693. Epub 2019 Oct 28. PMID: 31657964; PMCID: PMC6883353.
Lenhart RL, Thelen DG, Wille CM, Chumanov ES, Heiderscheit BC. Increasing running step rate reduces patellofemoral joint forces. Med Sci Sports Exerc. 2014 Mar;46(3):557-64. doi: 10.1249/MSS.0b013e3182a78c3a. PMID: 23917470; PMCID: PMC3925193.
