Physiotherapy, Personal Training

Triathlon Knee Injury Case Study

How it started…..

A 35 year old female triathlete came to see us for both sided knee pain that she had been experiencing for the last 3 months. This initially started after a longer run than normal (10km). Up until this she had competed in only sprint triathlons where the running distance is 5km. Her goal was to do an Olympic distance triathlon where the running distance is 10km and so she upped her distance from her usual 7k to 10km. Following this 10km run she noted a vague pain around the front of both knee caps.

She rested for a few days and then ran again and pain came on in 15 minutes. She stopped and tried a cycle but this also hurt both knees. She also began to notice pain on sitting in work. She rested for a month and then tried running again but pain returned after 15 minutes. It was then that she came to see us.

What was the problem?

The assessment showed general tenderness around the outside of both knee caps. On gait analysis she showed poor hip control with a some increased pronation (flat footed) in both feet.  Strength tests showed weakness in hip and quadriceps strength. A single knee bend was also quite painful on both sides.

This patient was diagnosed with patello-femoral pain syndrome (PFPS). This is extremely common in runners. The common cause for this injury is an adverse amount of stress travelling through the patello-femoral joint (the joint between the kneecap and the thigh). Muscle weakness is a large factor in this injury as muscles such as the gluteals and quadriceps act as shock absorbers when running. If they are weak then the impact forces from running are transmitted to the patello-femoral joint. Over-pronation is also a large issue as it prevents the muscles from working correctly and means further decreases in shock absorption.

What was the treatment and outcome?

A comprehensive leg strength and core stability program for his patient was outlined. Manual (hands-on) therapy, sports taping and acupuncture were also used. This patient was also seen by our podiatrist who produced custom orthotics for her foot type. The combination of all the treatments produced very good results and she was back to her training regime in 4 weeks. She is now training for the London triathalon in July and is pain free- we wish her the best of luck!!