Historically, patellofemoral pain (pain around and under the knee cap) has been considered a ‘biomechanical issue’, requiring treatment to be focused on knee alignment. Such reasoning laid the foundation for inner quadricep strengthening to influence patellar tracking, foot orthoses, and knee taping and bracing. But is this correct? Many individuals suffer from ongoing pain despite correcting their biomechanics.
So what do the experts say?
Research led by Dr Michael Rathleff of Denmark, showed that most adolescents with patellofemoral pain deemed themselves 100% following 12 weeks of education, and management of training loads combined with an exercise program. No orthoses, no movement retraining, no brace or taping… but ensuring proper understanding of how they should modify their activities in the short-term, before gradually building their way back up to higher levels of activity or sports based on their level of symptoms.
Jean-Francois Esculier from the Running Clinic in Canada, performed a similar study, randomising 69 runners into 3 groups. The first group of runners were educated on how to manage their training loads to pain. They were instructed to modulate training so that pain during and after running was no higher than 2/10. Then, when symptoms were kept within appropriate levels, running distance could be increased gradually before adding speed and hills. The second group of runners got the same education plus an exercise program targeting the quadriceps as well as hip and trunk muscles. Finally the third group got the same education also, alongside training to modify their running pattern to reduce loads applied to their knees (increase step rate, run softer and avoid rearfoot striking for some).
Despite targeting all the factors we think are related to patellofemoral pain, namely biomechanics, no additional benefits were seen amongst the groups, compared to education alone!
We at Foundation Clinic agree that biomechanics is not the answer. There are lots of runners out there who are not injured despite exhibiting atypical mechanics, and also runners with ‘good’ alignment that sustain injuries. Recent increases in training load, or decreased capacity to sustain loads (due to stress at work or lack of sleep) are more predictive of injury. Education is key!
For more information contact Foundation Clinic on 579 5601, or email [email protected]
Foundation Sports and Rehabilitation Clinic
78 First Ave, Tauranga, 3110