A Rolfing Perspective on Runner's Knee

A recent client came to my office with a diagnosis of Runner's Knee. I must admit, I had never heard of this term, despite 6 years of working with runners and triathletes. A quick internet search revealed that Runner's Knee is characterized by pain around the patella, often caused by patellar misalignment, and most often treated with physical therapy to strengthen the medial quads.

Any pain or crepitis around the patella is cause for concern, because damage to the patellar cartilage is by and large irreversible and a painful, frustrating condition for any athlete. Preventing the loss of cartilage is a key focus of my treatment plan in such cases.

Many clients do not undergo physical therapy due to lack of insurance or lack of funds, or both. Also, having undergone physical therapy for my own patellar issues and finding it impossible to even do the exercises without increasing my pain level (and, I suspect, further damaging the patellar cartilage), I am skeptical of the long-term viability of strengthening those quads in order to treat the issue. Once the patient stops doing the exercises, it would seem logical that the original condition would return as the muscle weakens to its normal state.

So what to do with Runner's Knee? With this particular client, I began with the foot. Incredibly tight calves has led to a rotation in her calcaneous, or heel bone, essentially causing her to over-pronate with every step. This pronation led to a counter-rotation at the knee, putting undue strain on her patella, caught as it were between an unstable ankle/lower leg complex and overcompensating quads.

Further investigation revealed a gait pattern that overemphasizes the quads as the primary hip flexor. An efficient gait uses the psoas, and by extension, the spinal engine, as the primary hip flexor. This imbalance exacerbated her symptoms, as tight quads are the main cause of her patellar pain.

Balancing this client's foot and knee and normalizing the tension in her quads led to a dramatic decrease in her pain level and a resumption of activities that previously were too painful to perform. After two sessions, she does those activities pain-free. The next step is to activate and prioritize her psoas in walking.

I am confident these structural changes are long-term. They are not dependent on continued strengthening exercises, and were achieved after only two hour-long sessions. Better yet, this young client is that much more unlikely to suffer debilitating arthritis or cartilage loss due to a structural imbalance. This is a testament to the benefit of addressing structural issues in athletic injuries, and is the kind of outcome I see on a regular basis. Rolfing rocks!