A few months ago, I saw a young woman in my office complaining of knee pain. She had just started running and after several 30-45 min straight runs developed anterior knee pain. Even before I examined her knee I knew she had developed patellofemoral pain syndrome (PFPS).
She had been a competitive swimmer in high school and hadn’t done any running before this. She just decided one day she was going to start running. I admired her.
Her knee examine was pretty straight forward. I was able to elicit pain along the inferomedial aspect of her patella; she had a very minor joint effusion, but otherwise the rest of her exam was normal.
I spent the rest of the visit counseling her on what PFPS is and how it happens. I spoke about imbalance in the muscles around the knee and showed her specific quadriceps strengthening exercises. I suggested she take a regular dose of an anti-inflammatory medication for at least a week if she was in pain. I advised her to get a proper gait assessment done for her running shoes and told her she had to stop running for a few weeks at minimum. She obviously didn’t like that last part but I reassured her that she would get back to her running if she listened to her body and took the proper steps to heal and strengthen her legs, particularly the quadricep muscles.
She returned to see me about six weeks later for a different reason. I asked how the running was going. She told me she took my advice and her knee feels great.
Remember that saying, “doctors make the worst patients”? It really is true. Ten days ago, at the first sign of knee pain, though I did “rest” I didn’t take any medication and I didn’t do the exercises. Granted I was on vacation with my family so having any time to myself to exercise was difficult. There were a few mornings I found myself alone on the deck so I did squats and yoga but it clearly wasn’t enough.
But, since the run two days ago, I have been faithfully doing my quad strengthening reps and taking acetaminophen for the pain. Normally I would be taking Ibuprofen but it’s been upsetting my stomach of late. I’d forgotten what a good painkiller acetaminophen can be; there have been moments when I think I could run again, my knee feels almost back to normal. Gone is that annoying ache I experienced walking down the stairs! But I know that is the Acetaminophen working. Not to worry, I told myself no running for another week, at minimum.
These particular quad sets, I find, are very helpful, but there are many more that are equally important. Not only should I be strengthening the quadricep muscles, I also need to remember that the gluteus muscles and the hamstrings are key to a healthy knee as well. I found this PDF to be particularly helpful. And just to prove that I am practising what I preach this time, here is a short video of me doing a quad set. (And yes, that’s Katy Perry in the background and at the very end, my son demanding attention.)