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“Runner’s Knee” is a catch-all term for pain around the kneecap (patella). Medically, it is usually Patellofemoral Pain Syndrome (PFPS) or Patella Tendinopathy. It is the sharp pain when you go downstairs, the ache after sitting for too long with bent knees (Movie-goer’s sign), or the stabbing sensation 5km into a run.
For runners and active individuals, this diagnosis is frustratingly vague. You are told your kneecap is “tracking wrong” or your cartilage is “soft” (Chondromalacia Patellae). You are given generic quad strengthening exercises and told to rest. Yet, the moment you return to running, the pain returns.
At Breakthrough Pain & Performance, we understand that the knee is a slave to the hip and the foot. It is a hinge joint caught between two ball-and-socket joints (the hip and the ankle). If either the hip or the foot is dysfunctional, the knee takes the torque. We treat the Neurological Kinetic Chain. We identify why your brain is loading the knee incorrectly and fix the mechanics at the source.
You have likely been told your glutes are weak. You have done the clam shells and the bridges. But the pain persists. This is because your glutes are likely not weak; they are Inhibited.
Inhibition is a neurological state. The brain has disconnected from the muscle. This often happens due to Reciprocal Inhibition. If your hip flexors (Psoas/TFL) are tight from sitting at a desk all day, the brain reflexively switches off the opposing muscles (the Glutes).
When you run, your brain wants to use the glutes to stabilise the pelvis. But if they are inhibited, it cannot access them. Instead, it uses the Tensor Fascia Latae (TFL) and the IT Band to stabilise the hip. The TFL attaches directly to the kneecap. When it is overworked, it pulls the kneecap laterally (to the outside), causing it to grind against the groove of the femur.
No amount of glute strengthening will work if the hip flexor is still tight. We release the brake (the hip flexor) first. We use P-DTR to reset the tone in the front of the hip. Once the inhibition is lifted, the glutes fire spontaneously, the TFL relaxes, and the kneecap tracks centrally again.
The Vastus Medialis Oblique (VMO) is the teardrop-shaped muscle on the inside of the knee. Its only job is to pull the kneecap inwards to counteract the outward pull of the large thigh muscles.
In almost every knee injury, the VMO is the first muscle to shut down. Swelling inside the knee joint (even a tiny amount) triggers a spinal reflex that inhibits the VMO. This is Arthrogenic Muscle Inhibition.
Once the VMO is asleep, the kneecap is pulled laterally with every step. This causes the cartilage to wear down on the outside edge. You can squat all day, but if the VMO nerve signal is blocked, you are just building the other muscles and making the imbalance worse.
We use specific neurological activation techniques to wake up the VMO. We clear the swelling reflex. We teach the brain to find the muscle again. Once the VMO is active, it acts as a dynamic guide-rail for the patella, stopping the grinding pain immediately.
When your foot hits the ground running, it should pronate (roll in) slightly to absorb shock. This causes the tibia (shin bone) to rotate internally.
If you over-pronate—perhaps due to a lazy arch or a stiff ankle—the shin bone rotates too much. The femur (thigh bone), however, is being controlled by the hip. If the shin twists in while the thigh stays straight, the knee is rung out like a wet towel. This torque stresses the patella tendon and the cartilage.
We assess your foot control. We don’t just put you in orthotics (which act as a crutch). We retrain the intrinsic foot muscles and the brain’s control of the arch. By teaching you to create a “short foot,” we stop the excessive internal rotation of the shin, sparing the knee.
If your pain is in the tendon itself (just below the kneecap), it is Patella Tendinopathy. This is a degenerative condition where the collagen fibres become disorganised.
Crucially, tendon pain is largely cortical. The brain becomes hyper-vigilant about the tendon. It perceives load as dangerous. This leads to protective stiffness in the quads, which pulls on the tendon more, creating more pain.
We use Isometric Loading to treat tendon pain. Heavy, static holds have been shown to be analgesic (pain-relieving) for tendons. They reduce the cortical inhibition and allow the muscle to relax. We combine this with P-DTR to desensitise the tendon receptors. This breaks the pain cycle and allows you to begin strengthening the tendon without flaring it up.
1. The Release: We release the tight structures pulling the kneecap off-track (IT Band, TFL, Lateral Quad).
2. The Activation: We wake up the VMO and the Glute Medius to stabilise the limb.
3. The Mechanics: We fix your foot control and running form to stop the twisting torque.
4. The Load: We gradually load the tendon to rebuild its capacity, using isometrics first, then eccentrics, then plyometrics.
This clinic is for you if:
We get to the root of the tracking issue.
