Knee pain may come and go or be gradual in onset making it easy to ignore. It may be difficult to recall why or when the pain started. You may think knees just hurt and it goes away when you start running. But ignoring nagging knee pain will lead to injury.
Pain in the front of the knee may be a condition known as Patellar Femoral Pain Syndrome (PFPS). PFPS has been found to be linked to a muscle imbalance specifically involving the quadriceps muscle group and hip musculature. Weakness in the hip abductors and external rotators will compromise your running alignment and this leads to front of knee pain, likely PFPS pain. If the hip abductors and external rotators are not strong, the hip and femur will go into adduction and internal rotation sometimes called “kissing kneecaps." This motion stresses the medial (inside) and (front) anterior knee joint and tissue. The quadriceps muscle-tendon group is loaded and misaligned causing imbalance and strain.
We see this with runners at our LoHi PT clinic and the research seems to validate it. An 8-week study of individuals with anterior knee pain compared strengthening the hip musculature first versus strengthening the quadriceps musculature first. Patients in each group performed isolated exercises for four weeks. The hip group performed isolated hip strengthening exercises while the quadriceps group performed quad strengthening only.
During the second four weeks of the study, both groups performed functional exercises that combined hip and quadriceps strengthening. It was found that those who did the hip strengthening first had better outcomes with reduction of pain and improved function. When tested at the four-week mark, the hip group had significant improvement in pain levels while the quad group did not. At the end of eight weeks, both groups had improvement but the hip group had more. The researchers think that the hip group may have had better outcomes due to the hip strengthening better preparing the knee for functional activities. It is also believed that the quadriceps (group) exercises may have irritated the knee more initially, while the hip group allowed the knee to rest and calm down.
In summary, a little prevention can go a long way in decreasing your chance of a knee injury that may sideline your running. Good strengthening and body awareness to use your hip muscles during your running will help control the alignment of whole leg throughout the running cycle, each step of the way. See the full article and research reference at: articles on our website www.LoHiPT.com.
Contributed by Karen Voss with RunningWell.Clinic and LoHi Physical Therapy in Denver, Colo.