Evidence based treatment of knee pain in runners

...an accurate diagnosis and multi-modal treatment is critical

The knee is the most common area of injury in runners. This article reviewed the current literature for recommendations for physiotherapy interventions in Patellofemoral pain syndrome (PFPS), Patellar tendinopathy (PT), and Iliotibial band friction syndrome (ITBFS).

PFPS is often thought to be due to aberrant tracking of the patella, and several factors such as biomechanical alignment, decreased flexibility and muscle weakness and imbalance may contribute to this injury. ITBFS on the other hand is caused by compression of the distal iliotibial band (ITB) on the lateral knee. The increased pressure leads to irritation and inflammation of blood vessels and nerves on the lateral epicondyle of the knee. PT has several phases: the initial phase is an acute overload, which when present over a prolonged period causes tendon thickening and inflammation, followed by tendon tissue breakdown and chronicity.

This article highlights three commonly reported injuries with running, especially for those patients with a sudden increase in running mileage.

While the three diagnoses discussed can present with similarities, it is important to correctly diagnose and accurately address the specific exercise and soft tissue needs.

The authors of this article also highlighted a need for a multi-modal approach to therapy and careful consideration of the individual biomechanics for each patient.

> From: Mellinger et al., Ann Transl Med 7 (2019) S249 . All rights reserved to Annals of Translational Medicine. Click here for the online summary.

Expert opinion

This article may be especially well-suited during the 2020 COVID-19 pandemic, as several studies have shown a worldwide increase in runners, partially due to lack of access to gyms and fitness facilities.

Furthermore, the treating clinician should also take into consideration that many runners will also have had an increase in running mileage, due to lack of alternative exercises or activity during the pandemic.

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