Summer in Colorado brings warmer temperatures, longer days and inevitably more time spent outdoors. Many Coloradans choose to take advantage of summer by hiking or running on our vast network of urban and mountain trails. Oftentimes, this increase in miles traveled on our feet can lead to pain in and around the knee, specifically the kneecap. This pain is technically termed patellofemoral pain syndrome, but is commonly referred to as hiker’s or runner’s knee.
How Do I Know If I Have Hiker’s Or Runner’s Knee?
Another sign that you may be at risk for developing hiker’s or runner’s knee is a knock kneed (valgus) position during activities like squatting or walking up or down stairs. This position makes it more likely that your knee will become irritated or painful. The hallmark sign of hiker’s or runner’s knee is pain around or under the kneecap. This pain is usually worsened with squatting and walking up or down stairs or hills.
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What Is Patellofemoral Pain Syndrome?
Patellofemoral pain refers to pain arising from excessive or faulty contact between the kneecap (patella) and the bottom portion of the thigh bone (femur). The patella lies in a groove between two rounded portions of the bottom of the femur. It is essentially like the patella is sitting in a valley between two hills.
During weight bearing activity where the knee is bending and straightening (such as walking, hiking or running), the patella glides up and down in the valley between the hills. If the patella does not glide perfectly in the valley, it may grind awkwardly on one or both of the hills. This grinding causes irritation, popping, pain and sometimes swelling.
What Causes Patellofemoral Pain Syndrome?
The patella is a sesamoid bone, meaning that it is suspended between two tendons rather than being attached to another bone by a ligament. The top portion of the patella is connected to the quadriceps tendon, which then attaches to the quadriceps muscle group. The bottom portion of the patella is connected to the patellar tendon, which then attaches to the shin bone (tibia). This unique arrangement allows the patella to be pulled one way or another based on variability in muscle strength and flexibility.
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The most common strength/flexibility issue leading to patellofemoral pain involves weakness in muscles on the inside of the thigh (vastus medialis obliquus) coupled with tightness in the muscles and tendons on the outside of the thigh (vastus lateralis, iliotibial band). This weakness on the inside and tightness on the outside pulls the patella to the outside, causing it to grind up on the lateral hill rather than gliding perfectly in the valley.
Another common flexibility issue leading to patellofemoral pain involves tightness in the muscles on the back side of the thigh, also known as the hamstrings. Tightness in the hamstring group pulls the shin bone backwards, thus increasing the amount of force with which the patella is sitting in the valley. This increased force can lead to grinding and irritation between the patella and the femur, even if it is gliding in the correct portion of the valley.
How Can Trigger Point Dry Needling help?
Trigger Point Dry Needling (also known as functional dry needling or intramuscular manual therapy) involves inserting a tiny filiform needle into a taut band of muscle tissue, also known as a trigger point. This causes the muscle to momentarily cramp and eventually release. This treatment option is extremely effective in releasing muscle tension and restoring normal flexibility and function rapidly.
When addressing patellofemoral pain, releasing muscle tension and restoring normal muscle flexibility can decrease the likelihood that the patella will be pulled out of the valley and cause grinding, irritation and pain. Releasing tension in the hamstring group can help decrease the amount of force with which the patella is pushing into the valley. Coupled with specific strengthening and stretching exercise as prescribed by your Physical Therapist at Therapydia, Trigger Point Dry Needling is an effective tool in combating knee pain in hikers and runners.