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Patella femoral pain syndrome – aka the silent killer known as “god damn it my knee is still hurting

Wow, that’s a fancy word right – cool thing to throw around with at the weekly running group. Well, the truth is it can really mess up your whole body up radiating up to your head leading to headaches and other pleasurable side effects if the knee discomfort isn’t enough.

Generally speaking, always consult a doctor or a physio about your issues if you are in servere pain!

What is it?

Starting from minor symptoms like : stiffness around knee especially right under knee cap up to more major symptoms such as: pain at the knee when walking down stairs or doing a low single leg squat.

At the beginning, that feeling of stiffness might disappear after your 10-20min warm up phase and return after the activity, more obviously after high intensity intervals etc. It can progress over time if you neglect it and lead into stinging pain at the front of the knee when even attempting to run or cycle. Swimming will probably not affect the pain as much except for the later stages of this fun journey – except for strong push offs the wall or hard kicking sets.

How to do I know that I’m the lucky one?:

When I get this on a referral from a doctor, in 90% of the cases I will re-do my diagnoses and do a quick check of the most important joints relating to it. In most cases the problem is NOT the knee my friend.

  1. Check the range of motion / mobility and strength of foot / ankle, knee, hip, lower back.

  • Did you notice an obvious restriction in comparison to the other side when stretching or moving? Any past problems in this area? For mobility: stretch all the key muscles from foot to lower back – calfs & tibialis anterior area – hamstring & quads – gluts & hip flexors – lower back area especially quadratus lumborum and erector spinae.

  1. Quick functional test (especially for runners) single leg squat barefoot – on a wobbly matt if too easy.

  2. A thorough chat about daily activities, sport, history of injury etc.

  • Regarding daily activities: do relax in the chair after your workout or do you have a 8hours standing/lifting/sweating job – obviously affects your training. Do you have other stressors in life next to work and training – family/ friends/ partner commitments, too much or too little of any with bring you out of balance and increase likelihood of injury. Regarding sport: how long are you in the sport? Quick increase in volume/ intensity – a real classic and recipe for disaster. Regarding history of injury: where, what, when for how long? If still struggling with it – why?

What can I do?

Don’t overcomplicate things and go doctor shopping, pills and injections are not going to solve your problem long term. You need to find the root of this issue.

Make it black and white if possible:

I know I know it never is but lets try. I would say generally speaking one can divide most orthopaedic problems in two kinds of “roots”:

  1. Load on (training stimulus, work load, family/friends/partner commitments, etc.)

  2. Load off (hitting the couch and bed, sleep, nutrition, stretching, massages, foam rolling, compression, ice baths, sauna etc.)

If those two buddies are out of balance, you’re starting the stopwatch to your first injury. The human body is brilliant in compensating and finding away for you so you can still hit that hard interval session with your friends on Tuesday eve. He can do it for maybe a few months, maybe even a year or two who knows. In the end though, it will result in your body giving you clear signs that he does NOT like what you are doing with him. This brings me to “polar’s” slogan and the cheapest advice anyone can tell you: listen to your body. Wow brain freeze right, brand new stuff – never heard that before. Many people say they do it, but actually consciously decide against listening on a frequent basis. Let’s say you struggle with patella femoral pain, you can’t tell me it just started yesterday and now all of a sudden you have this excruciating pain, otherwise I would ask you to stand in the corner for a few minutes while I watch your nose grow Pinocchio style.

So what to do:

Load on: make sure you don’t overload yourself – imagine a bucket of water, you can’t overfill it or it will drop over the edges. Make sure you do not cut short on any of the points mentioned above, life is short and you don’t want to sacrifice that just because you want to run around on an island in the pacific one day. Talk to your coach and peers if you are not certain if it’s in balance.

Load off: Let’s face it, most type A triathletes have no problems hammering that unit, but when it comes to off time (I do not mean going for a chill run for two hours with friends) many struggel. You will need to learn how to be alone without constantly being exposed to media, the web etc. Learn to take it easy and train it. Use the points I mentioned above to get into it.

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