At first it was just a niggle in your knee when you climbed stairs or were squatting. Then the pain and stiffness became more than a niggle and you began to feel it when walking, sitting and resting.
You may be hearing popping or cracking sounds in your knee, and notice that your knee “gives out” every now and again.
The knee is an amazing but complicated joint and knee pain is one of the most common reasons that people visit a physiotherapist.
Pain behind the kneecap is commonly called runner’s knee because it is often seen in athletes and people with an active lifestyle, although it can also be seen in everyone from the young adolescents during growth spurts to elderly people.
The medical term is patellofemoral pain syndrome. It is pain behind the kneecap where your patella (kneecap) slides along the groove in your femur (thighbone) beneath.
Pain and stiffness occurs when the kneecap does not slide smoothly and misaligns causing it to rub against your femur. Repeated mis-tracking causes pain, stiffness, and ultimately can cause damage to your kneecap joint surface.
Knee pain is most commonly noticed during activities that involve knee bending, jarring or weight bearing.
People most at risk are those whose sport or activity includes running, jumping or the need to land in a squatting position. Sports most commonly associated with knee pain include running, netball, volleyball, basketball, tennis, skiing and cycling. Many tradies such as tilers and carpet layers also have problems.
Causes of Runner’s Knee
Overuse – increased activity or increased duration and intensity of the activity
Changes in footwear or playing surfaces
Tight outer thigh muscles and weaker inner thigh muscles causing the kneecap to be pulled to one side
A twisting injury
Flat feet and lack of arch support
Weak hip control muscles
First aid for Runner’s Knee
Generally, knee pain is gradual onset, which means it gradually increases in severity over time.
As with most injuries, the best initial first aid is rest, ice packs (15 minutes at a time every 2-3 hours), and taking anti-inflammatory painkillers such as ibuprofen.
You do not need a referral from a doctor to see a physiotherapist. If the pain is moderate, then you can seek treatment with your Physiotherapist immediately.
Physiotherapy is a proven treatment for runner’s knee. Your physiotherapist may initially tape or strap your kneecap to help pull it back into alignment and reduce pain.
Massage and joint mobilisation techniques are also commonly used to reduce swelling and restore movement.
You will be prescribed exercises to stretch and strengthen muscles that may be contributing to the problem. These exercises will change as you heal and will gradually increase in intensity to match your recovery.
If you wish to continue exercising to maintain your fitness during your treatment, then explore swimming, deep-water running and low-impact gym equipment such as elliptical trainers.
Depending on your knee pain cause, you may also be advised to explore arch supports, orthotics or different footwear. You may also require postural or technique correction in your chosen sport to stop problems from recurring, as well as a strength and conditioning plan to get you back to full competitive fitness.
In our experience, over 90% of runner’s knee physiotherapy clients will be pain free within six weeks of starting treatment. However, for severely damaged joints or arthritic joints, surgery may be required.
Things to Remember
Runner’s knee or patellofemoral pain syndrome is a common cause of knee pain.
It is a gradual onset injury and is most commonly noticed during activities that involve knee bending, jarring or weight bearing.
Physiotherapy is a proven method to speed healing, and prevent recurrence of knee pain.
Future management may also involve assessment of your gait and posture during exercise, and prescription of arch support or custom made orthotics.
Common Soccer Injuries
As a dynamic, high speed game where physical contact occurs both incidentally and deliberately, soccer creates many circumstances where injury may result. Most soccer injuries are relatively minor in terms of the degree of disability created; more serious injuries often result through the execution of a hard sliding tackle or other sudden physical collisions between players. Data from researchers regarding soccer injuries indicates that there are over 150,000 soccer injuries reported annually in the United States, among a playing population of over three million athletes; approximately 45% of these injuries occur in players under the age of 15 years.
As would be expected in a sport that centers on kicking a ball, injuries to the lower legs are the most common injuries in soccer. Ankle sprains are another common occurrence, often created by either an awkward plant of one of the feet while running or changing direction, or by stepping on another player’s foot, causing the ankle to twist forcefully. Most soccer players wear a cleat that is low cut to permit greater maneuverability, and this footwear is not naturally supportive of the ankle.
The Achilles tendon is vulnerable to two kinds of injury. Given the explosive movement required of a soccer player, the Achilles must instantly respond to the impulses of musculoskeletal movement. If the Achilles tendon is imbalanced in terms
Injuries to the lower legs, ankles, and feet are the most common injuries in soccer.
of either its strength relative to the connected muscles of the calf, or if the tendon is not sufficiently flexible, the fibers of the tendon can become overstretched or subjected to micro tears. The second type of injury to the Achilles results from the tendon being kicked from behind by an opposing player. The resulting trauma can significantly damage the tendon fibers.
Soccer players are subjected to numerous varieties of accidental kicks from an opponent in the course of play. Most of these kicks result only in contusions, as the players wear relatively durable shin guards. More serious injuries to the lower leg may occur as a result of a defender’s sliding tackle, where the defender slides forcefully along the turf to strip the ball from an opponent. If the tackle is not executed cleanly, the offensive player’s leg may be caught and twisted, the mechanics necessary for either a significant ankle sprain or a fracture of the tibia/fibula bones in the lower shin.
The knee can also be injured by a sliding tackle, if the offensive player’s leg is planted on impact and the knee joint is forced laterally (sideways); this type of collision prevents any of the force of impact being directed and absorbed anywhere but the knee joint. In such circumstances, the anterior cruciate ligament (ACL), a large connective tissue between the femur and the tibia in the knee joint, is at the greatest risk of injury. Other knee injuries occur in the same fashion as ankle injuries, where the leg is planted forcefully on an uneven surface, and the ultimate stress radiates directly into the knee.
Thigh injuries in soccer are typically one of two types. The first are contusions, as the thigh is exposed to all manner of physical contact in the course of a game. The second type of injuries are those common to all other running sports, muscle strains and pulls caused by repetitive and often explosive acceleration. Soccer players who have an imbalance in the function of the hamstring, which provides flexion to the knee, and that of the quadriceps, which gives the knee its ability to extend, will often experience injuries to these muscle and tendon groups.
Groin injuries are often the bane of the high-level soccer player. The structure of muscles, tendons, and ligaments in the upper thighs and the lower abdomen is complex; these tissues are also vulnerable to injury in soccer due to the almost constant lateral and stop and start movements that place stress on them. The abdominal injury that has attracted attention throughout the sports world that is popularly called a sports hernia is, in fact, a tear of the groin inguinal hernia, first identified among English professional soccer players in 1980. Such injuries require surgical repair.
Other than contusions, injuries to the upper body in soccer are less common. The collisions in the sport will occasionally cause a shoulder separation, which is damage to the acrimoclavical (AC) joint, the connection between the shoulder blade and the collarbone. Soccer goalies are more exposed to shoulder injury as a result of diving across the crease to make saves and striking the goal post.
Head injuries may occasionally arise due to collisions with opponents—concussion and damage to the player’s teeth are the greatest risk. Many players wear mouth guards to protect their teeth, which has the additional benefit of reducing the effect of concussions by keeping the tempomandibular joint (TMJ) from being driven upward into the skull. Since the mid-1990s, there has been controversy in the international sports science community as to whether the repeated heading of a soccer ball will cause damage to the brain or to the muscles and structure of the neck. Various studies initiated by soccer nations have not yet resolved this question.