Knee Overuse InjUrIES

As the weather turns nice, more people will head outdoors for their favorite activities including running, cycling, and spring sports like baseball, soccer and track & field. Inevitably, as this happens, we as physical therapists begin to see more overuse injuries, particularly of the knee. The term overuse injuries has received a bit of backlash recently, maybe for good reason, as the cause of these injuries is not so much “overuse” as it is a lack of preparation, or loading tissues at a higher threshold than what they can handle. Some of the most common knee overuse injuries with associated signs and symptoms are listed below: 

Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome is also known as “Runner’s Knee” due to its high prevalence in runners. Pain is located in the front of the knee, right behind the knee cap. People who have this injury most often complain of pain while running, pain while squatting, and pain when going down the stairs. Usually swelling is minimal. 

Patellar Tendonitis

Patellar tendonitis is sometimes referred to as “Jumper’s knee”. It is an inflammation of the patellar tendon, which is located right below the knee cap. Pain can be dull or sharp and there may be some swelling. Activities that make the knee feel worse often include running,  jumping, squatting or going down the stairs.

Iliotibial Band Syndrome

Iliotibial band syndrome presents as pain on the outside of the knee. It will be tender to touch at that location. It is most commonly exacerbated by activities that involve repetitive knee bending and straightening, such as in running and cycling. 

Bursitis

There are a number of bursa (fluid-filled sacs) in the knee that are meant to decrease friction between tendons and bones. One of the most commonly irritated is the pes anserine bursa located 2-3 inches below and to the inside of the knee. It can be aggravated by faulty body mechanics when running, swimming and squatting. When inflamed, it will be tender to touch and often slightly swollen. 

Diagnosing the Cause of Knee Overuse Injuries

The location of knee pain is beneficial in determining which tissues are irritated and inflamed. The first goal in treatment is to decrease pain and inflammation at the site of pain. But from there, we want to know WHY the tissues became inflamed and irritated in the first place. This is necessary in order to keep the pain at bay and prevent it from returning weeks or months down the road. 

Typically when it comes to overuse injuries at the knee, the location of the knee pain alone is not helpful in identifying the root cause of the injury. And in most cases, the cause of an overuse injury at the knee has little to do with the knee itself. This makes sense when you consider that the knee is located between the hip (which controls the position of the leg as a whole) and the foot (whose function greatly influences the way impacts and stresses are absorbed at the knee). In other words, the poor knee often falls victim to whatever the hip and foot are doing (or not doing) above and below it. 

Treatment of Knee Overuse Injuries

What can be done to treat knee overuse injuries? Beyond the first step of decreasing pain and inflammation, we need to address any of the following factors that could be contributing to the root cause of someone’s knee pain:

Training Errors

Too much, too fast. Weather turns nice, we get excited, we start to train and we get injured. Why? Quite simply, your bones, ligaments, tendons and muscles were not prepared for the amount of tension you just placed upon them. In this case, treatment would include modifying your training plan as well as getting you started on a targeted strengthening program in order to gradually load your tissues at a capacity they can handle. 

Improper Body Mechanics

For simplicity’s sake, the knee does two things… it bends, and it straightens. When muscle imbalances and/or faulty body mechanics at the hip or foot do not allow the knee to be able to control it’s position outside of its normal bending and straightening motions, this can put abnormal stresses and strains on the knee, leading to pain. If improper body mechanics are suspected to be a contributing factor to your knee pain, treatment will include a body mechanics assessment (whether that be while running, cycling, weight lifting, swimming, etc.) and a targeted strengthening program for the hip and/or the foot. 

Change in Equipment

Knee overuse injuries are commonly observed in runner’s and cyclists alike. And when training errors and faulty body mechanics are not suspected to be a causal factor, then we want to consider any recent changes in equipment. For example, a change in running shoes. Different shoes will load the knee differently and for someone who deals with chronic knee pain, some shoes may be better than others. In a cyclist, a recent change in bicycle fit should also be considered as a potential cause. Even small changes in seat height or fore-aft positioning of the saddle can place load differently at the knee.

This blog is not intended to diagnose your knee pain, but rather to inform you of some of the more common types of overuse injuries at the knee and how a physical therapist may be able to help treat your symptoms. The treatments mentioned above are specific to Home Team Wellness and Recovery and may or may not be part of a treatment plan of another provider. If you suspect you are experiencing any of the above types of knee pain, please contact us by phone at 515-207-0172 to receive a free phone consultation to discuss how we may be able to help you.