How to treat it?
There are a lot of treatment options for patella-femoral pain and it is something that normally responds well to physiotherapy treatment. The treatment is not prescriptive and will be depend on where you are in your training and why you have developed symptoms. The main treatment options are as follows :
- Education – understanding why you came to have this injury as this will help to avoid recurrence. This is a key part of treatment. It is important to look back and see if you have made any training errors related to load or training surface.
- Rest or reduction in activity. Mostly there will need to be some alteration in running. If you are lucky it might just be cutting this back a little but if the pain is too severe you will need to rest to allow the irritation to settle. If you are training for a particular event then it is important that you keep up cardiovascular training where possible but using an alternative method that does not aggravate the symptoms until you are back to running.
- Taping – there is evidence to suggest taping can help in the short term to relieve pain and may allow you to continue running and start exercising the muscles in the thigh earlier. Some patients also find bracing helpful.
- Correct biomechanical issues mentioned in the risk factor section. This will involve assessing how you move and correcting this and normally requires the use of mirrors and videos to help to teach new movement patterns. It is likely to involve improving gluts and quads strength and activation and sometimes muscle stimluators may also be used to make changes more quickly if you are very weak. There are a number of different exercises which target these muscles including squats, single leg squats and lunges which may be used. Pain is a big inhibitor to muscle function so it is important that the exercises are comfortable. The way you execute the exercises and the specific point in your rehab they should be included is a crucial part of the success of the treatment. It is worth understanding that doing these exercises without appropriate instruction and supervision may make you worse.
Each person will present differently and some people may have tightness in there calves, quads and hamstrings that can affect the way they move and increase load through the knee and therefore soft tissue release and stretching may be appropriate. Mobilisations to the ankle and around the knee cap may also be used. However, issues in flexibility as a primary factor are probably less common than strength and control issues with patellofemoral pain. This means that stretching/rollering alone is unlikely to resolve your symptoms.
- Orthotics – if you do roll your feet in excessively then you may need an orthotic which is a sole you put in your shoe that helps to support your arch. This can be bought off the shelf or custom made by a podiatrist. If your feet only roll in a little then you may be able to improve the position of the foot enough with the correct pair of trainers.
- Anti-inflammatories – If you are unable to carry out normal functional activities without significant pain then a course of anti-inflammatories may be appropriate. If you are in training and have a race coming up then, with the advice of a medical professional, it may be appropriate to run with some pain and use anti-inflammatories to reduce the symptoms. This obviously risks masking pain and should be discussed with your doctor or therapist. If you chose to continue to train despite pain to compete in a race it is important you allow yourself time post-race to thoroughly address the issues surrounding why you developed the pain in the first place.
If you want to book an appointment with Rebecca or one of our other physiotherapists you can do so online or by calling the Threadneedle Street clinic.