Rebecca Nicholas, chiropractor and owner of Back 2 Balance in Brighton and Hove, describes what patellofemoral pain syndrome is and why it’s so common in runners. Rebecca loves nothing better than to see her community enjoy life through a healthy lifestyle and switched on nervous system.


What is patellofemoral pain syndrome

One of the most common injuries facing runners who are preparing for a marathon is patellofemoral pain syndrome. Carry on reading to find out what patellofemoral pain syndrome is, how to prevent it, and how to tell if it’s something serious, or something you can push through for the big race….

80% of running injuries are below the knee, and what’s called patellofemoral pain syndrome, or “runner’s knee,” is the most common. It affects about 33% of runners with an injury. Very similar if

not synonymous to a kneecap tracking problem. Patellofemoral pain syndrome (PFPS) is an overuse condition causing pain at the front of the knee underneath the patella, or kneecap. By definition, it doesn’t involve any structural abnormalities— so, diagnostic testing such as X-rays or MRI are normal. But, despite “normal” structures, PFPS can still greatly impact a runner’s ability to train.

What causes PFPS

It can be caused by a large number of factors, but it’s thought to be primarily from overuse and under-conditioning. Walking and running involve a complex set of movements and muscle activation patterns. The pain caused by PFPS can develop slowly and gradually or suddenly develop after a specific event. It is especially common after a change in training regime, over use without proper rest, or inadequate foot wear.

The knee pain can often be felt during running, going up or down stairs, sitting with bent knees, squatting and kneeling. The pain is often described as a diffuse pain around the knee and more localised pain behind the kneecap, typically in the consult the client says “achy with occasional sharp pains”. Sufferers can also experience crepitus (crunchy/grindy noises) and the knee can also give away.


What treatment advice can help PFPS

Patellofemoral pain syndrome typically resolves with rest and conditioning. You can prevent it by strengthening muscles that help the kneecap track properly. Having strong core, quadriceps, and hip muscles will accomplish that. Also, if the foot is rolling in or pronating, this can contribute to the patella tracking issue. If this is the case, over the counter orthotics may also be helpful. Lastly, you can also get a brace that may assist with proper kneecap tracking, although this is usually our last resort (we usually use taping techniques instead).

The Back 2 Balance chiropractors will assess each client for their specific enquiry, possibly do x-rays or MRI if diagnostically indicated. Once a probable diagnosis has been achieved, chiropractic adjustments, soft tissue work, exercise rehabilitation programme, dry needling, ultrasound, kinesiotaping, to name a few of the treatment modalities used by your Back 2 Balance chiropractors.

Advice from your chiropractors:

  • Yes, you can run through the pain, it’s not going to cause permanent harm. However, if your pain is increasing I wouldn’t recommend running through it, but if it’s a low level pain that gets better after warming up, then this is something that you can run through. Patellofemoral pain syndrome may be a recurrent problem for some runners. An evaluation for other causes and physical therapy are recommended if it persists. Give us a call on 01273 206868 if you would like a consultation with one of our chiropractors.
  • Sorting out your core strength (which refers to abdominal and hip musculature), is pivotal in maintaining a healthy running gait in endurance activities. It’s a chain: the hip impacts the knee significantly, and alterations in foot mechanics will also impact the knee. The knee is caught in the middle, so if there are alignment issues or strength deficits in the hip, or in the foot, the knee often suffers.
  • As well as core strength, training for the marathon should also include resistance training. Some research supports resistance training to help with injury prevention, as well as performance, even in endurance events, like the marathon. Try one or two times a week strengthening all major muscle groups while training. Specific to patellofemoral pain syndrome, you want to strengthen your core, hips, and quads.
  • Why not come in for a regular sports massage with one of our amazing massage therapists- it’s a good way to loosen your muscles after a run/race and help prep beforehand too.

In general, athletes who are fatigued are going to be at a higher risk for injury because they lose their muscle stabilisation. But, most running injuries are due to overuse. That’s why it’s important to space out runs so you don’t run more than two days consecutively. If you run three days in a row during your training, you set yourself up for overuse problems of tendinitis and inflammation of a variety of structures.


NB extra caution for why not to push through the pain at certain times…

Be careful when your problems cause you to limp or change your running mechanics, because you may be causing long term harm. I realise it can be hard to pause training, when you may have already put in so much time to get where you are. But, if you have something that’s causing you to change your running mechanics and you recognise that, don’t push through it. Also, if your pain is more than mild pain, e.g. > 3 on a scale of 1 to 10, that’s probably something more serious that you shouldn’t push through either. If this is the case, get it evaluated quickly, so you can have it addressed and get back to running. Call us on 01273 206868 to talk to one of our chiropractors. 

There are plenty of other causes of knee pain, not just PFPS, including a trapped nerve from your low back, osteoarthritis, tendinitis, quad or hamstring strain, ligament sprains etc. Read another of our blogs on knee pain here for some more insights and a couple of good stretches. If you haven’t already check out our YouTube channel for regular vlogs and exercises and stretches.

Here are some of our other related blogs on running:-

3 Top Tips for Improving your Running Technique

How much is too much when it comes to running?

So, to anyone running the Brighton marathon this April 2018, good luck and all of the Back 2 Balance team are praying for great running weather- not too hot or too cold, and limited wind. Call us on 01273 206868 if you need any advice or help with anything sports related- we do have some deals on for our marathon runners.