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Knee injuries can be categorized into acute or overuse/mechanical, of which we will focus on the latter for purposes of this article. The most common overuse knee injures comprise patellofemoral joint (PFJ) dysfunction, patella tendinopathy and iliotibial band friction syndrome (ITBFS).

Patellofemoral dysfunction (PFJ)

PFJ generally arises from a ‘maltracking’ kneecap. Research has reported women to be almost 2.5 times more likely than men to develop a patellofemoral pain syndrome in their lifetime.

This diagram illustrates the anatomy of the knee joint. In a normal functioning knee joint, the patella tracks up and down in its groove as the knee bends and straightens. When the kneecap begins to move to the outside as it bends and straightens, it is considered to be maltracking. People suffering this condition experience pain behind the knee cap aggravated by going up/down stairs, squatting and prolonged sitting.

Various factors contribute to a kneecap that tracks laterally. These include quadriceps muscle imbalance, stiff PFJ ligaments, poor knee alignment, poor foot alignment/control, hip weakness and hip muscle imbalances. In reality many of these factors co-exist. Management of this condition requires correct identification and correction of the above contributing factors. Your physiotherapist will guide you through this process.

Patella tendinopathy

The patella tendon sits below the kneecap and links it to the tibia tuberosity at the bottom of diagram 1. An abundance of knowledge has been learned about tendons over the last decade and we can now manage them with great confidence. In simple terms a tendinopathy is an ‘angry tendon’. Various cellular processes occur inside the tendon in response to sudden changes in load (either overload or underload). Pain is usually located at the bottom tip of the knee cap and has similar aggravating factors to PFJ dysfunction. One of the major differences that distinguishes the two is that tendinopathy usually improves with warming up while PFJ problems may potentially get worse.

Conservative management of tendinopathy usually involves load monitoring, tendon strengthening with eccentric exercises, and correction of any biomechanical abnormalities as mentioned above. Tendons have a really poor blood supply and new medical management can involve injecting patients own blood into the tendon to facilitate a healing response. These injuries can take anywhere from 6 weeks to 6 months to heal.

Iliotibial band friction syndrome (ITBFS)

The iliotibial band is a thick layer of connective tissue that runs down the lateral thigh from hip to knee (not shown on diagram). Irritation and inflammation can occur where it crosses the knee and rubs against a small fat pad. Patients will feel a pain in the outside of the knee generally worse with running downhill. Once again biomechanical factors and load play a huge role in the development of this disorder, and these must be priorotised by your physiotherapist.

Two themes that emanate from overuse knee injuries are load and biomechanics. When setting out on that fitness campaign it is imperative to gain professional advice on how to successfully build your fitness base. Fix any biomechanical abnormalities and adhere to a gradual load progression and you are giving yourself the best chance of reaching your fitness goals.

Shane O'Sullivan
Sports Physiotherapist
Lifecare Prahran Sports Medicine Centre