Do Your Knees Hurt with Running, Sitting, or Squatting?

Written by: Jesse Parsons, DPT

If you are having achy pain in your knees or specifically around your patella (kneecap) with prolonged running, sitting, or with stairs and squatting you may have a condition called Patellofemoral Pain Syndrome (PFPS). This syndrome is caused by irritation and inflammation of the articular cartilage on the underside of the patella (Chondromalacia Patellae) and can be due to various anatomical or biomechanical faults. This does not, however, have to be a lifelong struggle with pain as there are many ways to address the improper movement patterns around the knee that be used to return you to your optimal function. 


So what is PFPS? 

When the knee is working properly, the patella will glide smoothly between the femoral condyles in the trochlear groove (see image) during knee flexion and extension. With PFPS, this is not the case and can be due to multiple factors. If you have decreased mobility and/or muscular control at the hip and ankle, this will lead to an improper positioning and tracking of the patellofemoral joint especially during weightbearing activities. This causes an increase in the irritation of the cartilage beneath the patella. Weakness in the quadriceps muscle can also affect the pulley-like mechanics of the patella and play a direct role in patellar movement. Tightness of the connective tissue surrounding the patella (retinaculum) can be another big factor in improper patellar positioning. If the lateral retinaculum is too tight, it can pull the patella out of alignment during knee movements. When someone is suffering from PFPS, they may have one, two, or all of these impairments that contribute to their knee pain. 

What is the treatment for PFPS?

Physical Therapy can be used to alleviate the symptoms of PFPS by addressing the improper biomechanics at not only the knee, but also at the hip and ankle. A Physical Therapist will utilize various tests and measures in their examination to determine the cause of your specific knee pain and the impairments that need to be addressed. These impairments may be limitations in joint mobility, problems with muscular control around the hip knee and ankle, or simply weakness surrounding the joints of your involved leg. While PFPS is not limited to runners, a majority of knee pain with running can be attributed to the patellofemoral joint. If you are a runner, your Physical Therapist can utilize a running gait analysis to better understand what increased stresses are being put on your patellofemoral joint, and at what portion of your gait cycle they are occurring. Regardless of your activity level, your physical therapy treatment will be specifically tailored to your needs in order to get you back to an active lifestyle without being limited by knee pain.