Running & Patello-femoral Syndrome

• What is it?

The patella (knee cap) is a « floating » bone and it’s positioning is very dependent on the different tissues that attach to it, as well as the alignment of the leg. When the positioning of the patella is not quite right, it can cause stress on the joint between the patella and the femur (long bone in the leg) causing some pain around the patella.

• What are the causes?

• • Weak glutes: the glutes are some of the most important muscles to stabilize the pelvis and the leg during the stance phase. If the glutes aren’t functioning properly, this can cause a drop of the pelvis on the opposite side (called a Trendelenburg) along with an adduction of the hip (femur coming in towards the midline of the body) and a subsequent valgus of the knee (« knock » knee). This will alter the positioning of the patella in reference to the femur, which can cause stress in the joint between these two bones.
    • Weak glutes -> knee caving in -> poor leg alignment -> increased stress between knee cap and femur
  • Overpronation of the foot: if the arch is not able to properly stabilize itself during landing, overpronation of the foot (« collapsing » of the arch) can pull the tibia (shin bone) in towards the midline of the body creating a valgus of the knee as mentioned above.
    • Foot collapsing in -> knee caving in -> poor leg alignment -> increased stress between knee cap and femur
  • Heel striking: when heel striking, muscles of the posterior chain such as the glutes, calf muscles and intrinsic muscles of the foot are in a lengthened position, making it harder for them to activate, therefore increasing the chances of a poor leg alignment as mentioned above.
    • Heel striking -> poor use of glutes/calf muscles -> poor leg alignment -> increased stress between knee cap and femur

• How can you prevent them? 

• • Glutes strengthening: by strengthening the glutes, with both specific and functional single-leg exercises, these muscles will be more prepared to stabilize the pelvis and leg during landing, therefore maintaining a proper leg alignment
  • Foot intrinsics/tibialis posterior strengthening: by strengthening these muscles, you can more easily stabilize the arch of the foot during landing, also helping to maintain a proper leg alignment
  • Forefoot/midfoot striking: by forefoot/midfoot striking, the muscles of the posterior chain are more easily activated, in turn helping to maintain proper leg alignment as mentioned above
    • Different techniques can be used to encourage this forefoot/midfoot strike such as wearing minimalist shoes and increasing your running cadence. See previous blog posts for more details

• How can you treat them?
  • Making changes to your running technique: different interventions to your running technique, such as wearing minimalist shoes and increasing your cadence can encourage a forefoot/midfoot strike
  • Taping: kinesiotaping techniques can decrease the stress on the patello-femoral joint, athletic taping techniques can help support the arch of the foot
  • Soft tissue techniques: different massage techniques can help decrease the pull on the patella from muscles of the thigh
  • Exercise program: strengthening exercises for the glutes and intrinsic muscles of the foot (among others) can help stabilize the pelvis and keep a proper leg alignment while running