There are a number of common knee pain complaints that we see every day that are labelled as ‘overuse’ injuries. Overuse doesn’t necessarily mean that you as a person have overused that joint or body part (though it could well do!), rather than a soft tissue or connecting structure has been overloaded. In fact the cause may be from a change or increase in training, poor foot biomechanics, and often gluteal or hip weakness. The symptoms can be sharp, acute pain or a dull ache that lingers after activity – it varies depending on the condition.
Remember that pain is not equivocal to damage, rather it is a signal, and the more chronic the pain the more the signal may be interpreted abnormally by our brains!
This month’s blog article looks at the causes, symptoms and treatment for three overuse conditions that often cause knee pain:
– Patellofemoral Joint Pain Syndrome (PFPS or PFJ syndrome)
– Iliotibial Band Friction Syndrome (ITB syndrome)
– Patella Tendinopathy (Jumper’s knee)
Plus Knee osteoarthritis, which often underlies soft tissue changes in people over 40 years of age (yes, only 40!).
PFPS is pain arising from the tissues within or surrounding the knee cap (patella) and the femur (thigh bone).
Pain is typically a vague, overall tenderness at the front aspect of the knee and can be hard to localize. It is usually aggravated by activities that involves a high amount of knee bend (eg. up/down stairs, running (especially downhill), squats, lunges, sitting in a car, plane or cinema for prolonged time).
There are a number of risk factors that may increase the stress placed on the patellofemoral joint including lower limb muscle weakness, abnormal patellofemoral joint alignment, increased foot pronation, increased Q angle at the hip, weak external rotator of the hip (gluteals), change in training load.
Patella tendinopathy (jumpers knee):
Patella tendinopathy is a diagnosis of pain and dysfunction in the patella tendon. This condition presents with well localized pain in the patella tendon, usually at the attachment to the patella. Typically people with this condition have aggravation with activities that increase loading on the patella tendon such as running and jumping.
Risk factors for this condition are similar to that of PFPS, however the most common trigger is an increase in training volume and frequency and reduced quadriceps muscle strength and length.
Iliotibial band syndrome (ITB Syndrome):
The ITB is a thick structure called fascia that runs from the outside of the hip to the outside of the knee. ITBS is an overuse condition where pain is felt on the outside aspect of the knee. It was previously thought that this was caused by increased friction of the ITB on the bone outside the knee, with excessive knee bending movements causing inflammation and pain. Recent literature suggests that there is a highly innervated layer of fat between the ITB and bone that is responsible for the pain felt.
Common causes of ITBS are once again rapid increases in training volume and intensity, thigh muscle weakness particularly gluteal and quadriceps, increased foot pronation, poor movement control and poor tissue flexibility of the ITB and glutes.
The treatment of these issues involves addressing lower limb biomechanics that may be contributing to increased pressure on the injured structure including lower limb muscle weakness, increased foot pronation and poor movement control.
Soft tissue techniques including dry needling and massage can be effective in order to reduce sensitivity of tight muscles contributing to the injury.
Taping can also be effective in the initial phase of rehabilitation in order to offload injured areas and enable easier return to activity.
Load management is also a key component that needs to be addressed, as rapid increases or decreases in activity often lead to these injuries developing.
Your physiotherapist will be able to guide you through a specific rehabilitation program and which of these methods of treatment will be suitable to you.
Knee osteoarthritis (OA):
Knee OA is another condition not to forget when considering overuse injuries around the knee. This condition typically arises when people have changes in activity level (either too much or too little). Common symptoms are pain with weight bearing, reduced range of joint motion, sensation of the knee giving way and joint line tenderness. Our recent article discussing the latest evidence for knee OA and the GLA:D program will detail the appropriate treatment strategy in greater detail.