You are a distance runner-a competitive one or a jogger-or you play a sport that involves a lot of jumping, and your knee hurts. It hurts around the superior lateral aspect of the kneecap, or sometimes the superior medial aspect or deeper in the joint. You might have developed runner’s knee, more formally known as patellofemoral syndrome.
What is Runner’s Knee?
Normally, the knee cap, or patella, moves smoothly in the femoral groove, or trochlea, and it is protected by thick cartilage. Runner’s knee occurs when the knee does not move properly. Instead of moving up and down in a simple vertical direction during flexion and extension of the knee, it also gets pulled laterally, and over time this creates a thinning and deterioration of the cartilage, which can result in a condition called chondromalacia. Needless to say, there will be pain when walking or running, and often after sitting for a few hours. If chondromalacia has developed, creaking or crepitus may occur behind the patella during flexion and extension of the knee.
Why doesn’t the patella track properly? There are two different reasons.
- Muscle imbalance. Often, the medial muscle of the quadriceps group, the vastus medialis, will be weak, allowing the lateral muscle, the vastus lateralis, to pull the patella laterally. The iliotibial band is often overly tight as well and contributes to the lateral pull.
- Misalignment of the tibia and fibula due to a combination of pelvic and muscle imbalance and excessive foot pronation, which cause repetitive stress(1)
Acupuncture, together with myofascial release and rehabilitative exercise, can help. My approach with acupuncture is three-fold.
- Activation of the flow of healing energy in the meridians that traverse the knee. I also balance the energy of the whole body by choosing a combination of acupuncture points that are tailored to the unique needs of the patient. These two strategies in themselves will help with the pain. A classical strategy from traditional Oriental medicine, it is relaxing and can improve overall health.
- Treating local points around the knee to further stimulate the healing process.
- Addressing muscle imbalances with acupuncture trigger point therapy and myofascial release, modern techniques from orthopedic medicine. I will suggest therapeutic exercises as well.
How many treatments?
After a few treatments, the patient should feel a 20-30% improvement in pain. After more treatments, there will be a further reduction. If not, we discontinue therapy, as I don’t want they patient to invest more money if they are unresponsive. It is important for the patient to avoid any activity which exacerbates the pain during this period. Complete pain relief might take place anywhere between 8-16 visits. It is important to repeat that during the course of therapy we will be working to correct muscular imbalances that contributed to the problem. We want to avoid a recurrence in the future. (2)
(1) Matt Callison, L.Ac., Sports Medicine Acupuncture, San Diego, CA. Acusport Education, 2019, pp 862-863
(2) Ibid. p 867