SPORTS MEDICINE

Dr. Steve Badolato

RUNNER'S KNEE is a very common condition that affects not only runners, but others who train and compete in various activities and sports. Runner’s knee is also known in medical terms as patellofemoral pain syndrome or dysfunction (PFD).

As the name infers, patellofemoral dysfunction is an injury that occurs at the articulation between the patella, commonly known as the kneecap, and the underlying large bone of the thigh called the femur. Anatomically, the patella is a diamond-shaped bone which lies in a correspondingly shaped groove in the front of the femur, and is designed to function as a pulley, assisting the quadriceps by providing a mechanical advantage for added strength.

ONE OF THE MOST COMMON INJURIES among runners, runner’s knee most often strikes as runners approach 40 miles per week for the first time. The pain often feels worst when running downhill or walking down stairs.

PDF occurs under one of two broad circumstances – either when the patella is forced with excessive pressure against the underlying femur or when it tracks excessively on one side or other of the groove. In either case, this would cause irritation and abrasion of the cartilage of the patella, resulting in inflammation and pain.

Runners are not the only ones that experience this condition which is present in up to 50 percent of all patients that present with the complaint of knee pain.  PFD is characterized by diffuse, aching anterior knee pain that increases with activities such as running, climbing up or down stairs, kneeling, and squatting, all of which place additional loads across the patellofemoral joint.  Just sitting down for a prolonged period of time and then standing up can illicit symptoms of pain or tightness around the knee cap area which is outside the region of the major knee joint.

Clinical Symptoms Include:

• Pain behind the kneecap
• Pain worse after prolonged sitting
• Climbing stairs, particularly downstairs
• Jumping or squatting
• A feeling of instability or catching sensation of the kneecap
• Sensation of feeling or hearing snapping, popping, or grinding in the knee
• Occasional swelling around the knee cap

PFD typically results from overuse of the knee in sports and activities such as running, walking, jumping, weight training, or bicycling, and is commonly first noticed after a new workout routine or quick change in a short time in amount/duration and increased intensity of training.

The initial diagnostic evaluation should include a complete history focused on the knee which includes current and previous pain and/or problems. A comprehensive knee exam helps to rule out conditions which can mimic PFD, such as patellar tendonitis, patellar osteoarthritis, and quadriceps tendonitis, and X-rays of the knee can identify bony abnormalities, mal-alignment conditions and arthritis.

An initial conservative treatment approach to patients with PFD should focus on modifying the training/program that resulted in causing the condition with special attention to the biomechanics, and include the following measures: (1) relative rest with consideration of a temporary change to no-impact aerobic activity; (2) quadriceps strengthening; (3) evaluation of footwear; and (4) icing, especially after activity.

SHERNETTE HYATT is a 26-year old world class sprinter who was diagnosed with PDF. She underwent therapy at Beachside Physical Therapy in Indian Harbor Beach, Florida with focus on quadriceps strengthening and hamstring stretching. Shernette excelled in track at St. Johns University.

Definitive treatment should be individualized and concentrate on quadriceps strengthening and hamstring flexibility with an ultimate goal of returning to usual sport or activity. The addition of hip strengthening and stretching or stretching of the iliotibial band, hamstrings and calves should be based on a physical examination. Consideration should also be given to use of over-the-counter or custom orthotics. Also, utilization of a simple knee sleeve with a patellar cutout or strap may help.

NSAIDS (non-steroidal anti-inflammatory drugs) and Tylenol may be recommended.  Patient education is essential, and patients need to be given realistic treatment expectations. Most patients do well with conservative treatment, particularly if they maintain a disciplined approach.

Before Returning to Sport  or Full Activity

• Full painless range of motion
• Normal strength compared to other leg
• Able to jog and sprint without pain or limping
• Able to do 20 yard figure of eight runs
• Able to jump on both legs and injured leg without pain

Prevention of PDF centers around maintenance of optimal biomechanic function through appropriate shoe gear and foot orthoses as needed.  Maintenance of thigh (quadriceps) strength, especially the inside part of this muscle group, hamstring (back of thigh) flexibility and proper shoe wear with good arch support are imperative in preventing PDF.

Activities that involve repetitive and excessive patellofemoral joint compressive forces should be avoided. Squats, lunges, leg extensions and leg presses are all activities that apply considerable stress to the patellofemoral articulation, since they couple quadricep-intense resistance work with high degrees of knee flexion.

When the athlete’s specific sport or event requires that these types of exercises be performed (i.e. football lineman), they should be done carefully, and the athlete should be closely monitored to ensure optimal technique with regard to alignment and selection of specific strengthening parameters (repetitions, frequency and intensity). Overtraining, abrupt changes in training, or beginning a training regimen too vigorously in a short period of time should be avoided.

A Florida native, Dr. Badolato received his medical degree from the University of South Florida School of Medicine and did his residency training at St. Vincents' Medical Center in Jacksonville. Dr. Badolato is Board Certified and has fellowship training in sports Medicine with a specialization in non-operative musculaskeletal medicine. Formerly a team physicians at Ohio State University, he was also the medical director for the world-renowned IMG Bollettieri Sports Academy in Bradenton, Florida. You can reach Dr. Badolato at 321-253-2169, or log on to PremierUrgentCare.com

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