Those of us who train regularly are no strangers to the aches and pains of lifting and training. Even without regular exercise, knee pain can become a huge factor in graceful aging. It’s time to cut that pain off at the knee and figure out how to deal with it! Physician's Assistant and Earth Fed Elite Matt Shaw take us through the various steps of identifying and treating knee pain.
Patellofemoral Pain Syndrome - What the?
It is a vague term that encompasses multiple different conditions of anterior knee pain. It is also known as runner’s knee or jumper’s knee. In this condition pain can be located in a number of places including the inferior pole of the patella (aka the kneecap - most common), tibial tuberosity (bump at top of shin bone) and superior pole of the patella. The pain is a result of inflammation where the tendon attaches to the bone.
Why does this occur?
The most common causes of patellofemoral pain are overuse (hence the term runner’s knee), muscle weakness or imbalance and trauma. Tendons grow and adapt to stress, but they need recovery time to repair before further stress is applied. The onset of pain is a result of repetitive stress on the tendon greater than rate of the tendon’s ability to recover. Pain can also present due to muscular imbalance or weakness. When performing technical movements such as squats, deadlifts, cleans, or snatches, proper technique is not only critical for moving more weight, but also to avoid injury.
A few questions you can ask yourself to diagnose the cause are:
- How’s my mobility: ankle, knee, hip, low back, thoracic spine?
- Am I out of balance: quads vs posterior chain?
- Is it the result of a weakness: abductors, low back, hamstrings?
Finally, is direct trauma to blame? This may be the most obvious to people because it is a sudden and easily identifiable cause (direct blow, fall, surgery, etc.).
How do I know this is what I’m dealing with?
Patellofemoral pain commonly presents with point tenderness at the attachment site of the tendon to bone. Here’s a quick diagnostic test:
- Perform a few quick jumps in place resulting in increased pain in front of the knee.
- Then, try some isometric holds: wall sit, single leg wall sit, Spanish squat (depending on skill level, it needs to be difficult to work) for 5 sets x 45 seconds
- Re-test jumps. Patella femoral pain should decrease temporarily following these isometrics.
If pain persists, please contact local Sports Medicine provider for further evaluation
How do I treat my knee pain?
If your provider tells you to rest, ice, take NSAIDs and return to activity when your knee feels better, your best course of action may be to find another provider. While these things will lead to a temporary reduction in pain, it is very likely to return without proper rehab or addressing the actual cause of pain.
In incidents of overuse, the tendon needs to build up a threshold to be able to handle increasing loads. This can be done through a series of isometrics, eccentrics and volume loading exercises. High impact and explosive exercises like Olympic lifts, running and other sports performed too soon will likely result in a return of pain and prolonged recovery.
Muscle weakness or imbalance requires identifying the particular cause. This may be more difficult because it is not always as simple as working on the knee itself, but also the joints and muscles above and below. Work with a personal trainer or coach who is able to target the muscle groups needed for a solid recovery. As always, make sure recovery involves enough protein - check your ratios and be sure you’re helping both muscles and tendons to recover.
Trauma will require a period of healing and rest followed by proper rehabilitation with a gradual return to function.
Hopefully your patellar pain is a bit more clear and you’re able to understand the potential causes of such pain. Whatever your goals, the best way to recovery is to work with people you trust, and to know exactly what’s going into your body for recovery. Good luck and get back out when your body is ready!