Runners knee, also known as patellofemoral pain syndrome, is a condition where the patellar cartilage becomes irritated from contact with the femoral cartilage. It is commonly caused by overuse from activities like running that place stress on the knee joint. Specifically, it can result from overloading from excess weight, poor biomechanics, muscular imbalances, tight hip flexors, and other factors. A 24-year old cross country runner presented with knee pain diagnosed as runners knee. The treatment plan focused on equalizing tension on the patella, retraining the knee extensors, soft tissue work including myofascial release and stretching of the hips and quads, and exercises before progressing to full weight bearing and return to activity

1. I. Injury or condition - runners knee also known as patellofemoral pain syndrome
chondromalacia patella (kon-droh-muh-LAY-shuh puh-TEL-uh) - Softening of any
cartilage, patellalgia (pat″əl alґjə) - pain in or adjacent to the patella jumpers knee
and bikers knee. it is described as a condition in which the patellar cartilage
becomes irritated as it contacts the femoral cartilage.its most common in
physically active adolescent females.
Causes: major
A. Overuse from percussive activities that twist and jar the knee.
B. Overloading such as being overweight
C. poor alignment at the knee caused by
a. poor footwear
b. running on uneven surfaces which will change how forces moves
up the leg into the knee.
c. having flat feet or jammed arches
d. unequal development of medial and lateral quads.
e. muscular imbalances between quads, hams, and iliotibial band.
f. exaggerated Q-angle ( the angle formed by a line drawn from the
ASIS to central patella and a second line drawn from central patella
to tibial tubercle) or having valgus or knock- knees
II. Mechanism of injury or etiology - 24 year old x - country runner who was
experiencing pain in knee during running. saw the doctor and was determined it was
runners knee.
III. signs and symptoms -
A. pain felt on the anterior aspect of the knee
B. stiffness in knee after long periods of immobility
C. difficulty walking down stairs
D. crepitus during knee movement
IV. management plan -
V. Phase3 -
A. Goals: equalizing tension on the patella bilaterally and retraining the knee
extensors to take the patella appropriately over the joint.
VI. Estimated length of time of phase (ELT): 3 weeks
VII. Soft Tissue Rehabilitation:
A. Ely’s test - used to see if the rectus femoris is tight.
1. have client lie prone
2. flex the knee towards gluts
3. the calcaneus should get to 4 degrees or 6” for females, 6 degrees or 8”
to glutes.
4. any ipsilateral hip flexion during the movement in a positive read
B. Thomas Test
1. is a quick, simple assessment used to examine the length of the muscles
involved in hip flexion. Assessing their length can help you determine the

2. tightness of your client's primary hip flexor muscles, including the rectus
femoris, iliopsoas and iliotibial (IT) band. There are a number of things to
look at for each muscle group when assessing your client.
a) Begin the test by having your client sit on a bench or examination
table and position themselves on their ischial tuberosity—the
boney point we normally sit on. Take the client back so he or she
is lying in the supine position with less than half of the thigh off the
bench or table—the lumbar region of the back should be in
contact with the bench. Have the client bring both knees toward
the chest and then release one leg so it is extended and touches
the bench or surface.
(1) Assessment - If the client's lower leg touches the surface,
he or she has good flexibility in the iliopsoas. If the back of
the leg is even slightly off the surface, the individual has
tight hip flexors. If the knee is bent 70 degrees or less, the
rectus femoris (which crosses the hip and knee joint) is
tight. Finally, if the leg abducts or is angled outward during
the test, the IT band is tight.
C. lymphatic drainage on the in the patellar area to help decrease any swelling.
D. myofascial release on the Vastus Medialis, Lateralis and Rectus Femoris.
E. Petrissage to the quads following the length on each muscles with the thumbs
helping the muscles relax and also look for and knots to address later.
F. pin and stretch quads position client on edge of table to preform. This has the
effect of reducing restrictions that are located within the tissue
G. make nice with some petrissage and compression still looking for any
father restrictions.
H. met on knee
I. TPT on all quads
J. make nice
K. spreading of the hams prom supine position
L. retest
VIII. stretches and exercise
A. Static Stretching Techniques for the TFL and ITB
1. cross legs keeping injured leg on bottom
2. brings her hands together above her head. To create the stretch, the
client side bends to the side opposite the hip being stretched while
keeping her arms extended overhead
3. To create the stretch, the client side bends the trunk away from injured
side
B. Dynamic Stretching Techniques for the TFL and ITB
1. The client assumes a supine position with the legs approximately
shoulder-width apart.

3. 2. he client first lifts the knee out to the side and then swings the foot to the
front of the body to take the next step.This dynamic stretch addresses the
hip flexors, the hip abductors, the hip external rotators, the TFL, and the
quadriceps.
C. quads set
D. Straight-leg raises to the front
E. Hamstring wall stretch
F. Quadriceps stretch
G. retest
IX. exit criteria
A. able to bear weight move through all rom of knee without pain
X. work cited
A. A massage therapist’s guide to pathology
B. www.enacademic.com
C. www.ncbi.nlm.nih.gov
D. www.sportsinjuryclinic.net
E. http://www.slideshare.net/luzdavida/a-the-3-minute-305p
F. http://www.active.com/running/articles/active-isolated-stretching-exercises
G. http://www.triggerpointtherapist.com/blog/knee-pain-trigger-points
H. http://mydoctor.kaiserpermanente.org/ncal/Images/Patellofemoral%20Pain%20S
yndrome_tcm28-180773.pdf
I.