Patellofemoral Pain Syndrome is a broad term used to diagnose discomfort or pain around the patellofemoral joint. As the name would suggest, this joint is situated between the kneecap (patella) and the thigh bone (femur).
What is Patellofemoral Pain Syndrome?
It is broadly classified as an overuse injury in this region, which gradually worsens without any direct trauma to the area.
Multiple studies have shown that up to 33% of all knee injuries are related to patellofemoral pain syndrome [1]. While most people get positive outcomes after rehabilitation, up to three-quarters of people will eventually have to stop participating in physical activities (e.g. running, sports, etc.). Females are 2-10 times more likely to be diagnosed with patellofemoral pain syndrome than men, due to the different bone structures of the hip.
What causes Patellofemoral Pain Syndrome?
Given that it’s nicknamed ‘Runner’s Knee’, this condition is particularly common in running activities and sports. Other activities that can cause patellofemoral pain syndrome include sitting for a long time, squatting and jumping [1].
Especially when these types of activities are suddenly increased or performed repetitively, the knee may not be able to tolerate excessive knee bending forces.
Additionally, those with muscular imbalances and structural abnormalities (e.g. shallow knee groove, small kneecap dimensions, etc.) are also at risk of developing patellofemoral pain [2].
Our knees are complex hinge joints, designed to provide stability during movement in the leg as you walk, run, climb, and even kick. The patella, or kneecap, is a small bone attached to the lower end of the quadriceps muscle that moves in a groove at the front of the knee as the knee bends and straightens. The role of the kneecap is to protect the knee joint and also provide extra leverage for the quadriceps as they straighten.
When the quadriceps muscle is strong, the patella moves smoothly in its groove. However, if the quadriceps become weaker, or the direction of pull from the quadriceps muscles changes, the patella won’t slide smoothly in its groove. This can irritate the soft tissue between it and the knee joint, resulting in pain and this pain is known as patellofemoral pain syndrome (PFPS).
There are many factors that affect and change the directional pull on the patella. Here are a few:
Weakness of the quadriceps muscle. Any sort of knee pain will weaken the quads if you have experienced an injury to the knee. It could be a meniscal tear, a knee operation (including a total knee replacement), or even a bump to the knee. The quadriceps will start to weaken and change the way the patella moves.
Additionally, the outer muscle within the quadriceps is often stronger than the inner muscle, and as the quadriceps weakens, the strongest part of the quads will take over and change the directional pull on the patella. In this case, you not only have a painful and weak knee from the injury, but you may also experience even more pain from the PF syndrome.
Weakness around the hip and buttock region can change the biomechanics of the leg, which in turn, can change the directional pull of the quadriceps on the patella.
Pronated or flat feet. If you have flat feet or tend to overpronate your foot as you walk or run, the whole knee can roll inwards and change the way the patella slides in the groove as the knee bends and then straightens.
What are the symptoms of Patellofemoral Pain Syndrome?
The classic symptom of this condition is often reported as a dull and achy pain in the front of the knee. During aggravating physical activities, aching knees will gradually appear and worsen over time. Given there are a large number of structures in the patellofemoral area, symptoms can vary from person to person.
Other signs of patellofemoral syndrome, include:
- Pain during repetitive movements which require the knee to bend and load with body weight (e.g. stairs, running, etc.)
- Although less common, vague pain can also be felt around the patella and behind the knee
- Instability of the knee. This can also be described as the knee buckling, giving way or locking
- Excessive clicking and grinding of the knee whilst moving
How is Patellofemoral Pain Syndrome treated?
Patellofemoral Pain Syndrome responds well to treatment and in most cases, it can be treated conservatively without surgery or serious medical treatments. Physiotherapists and exercise physiologists regularly treat these conditions through a combination of different treatments. These treatments may include,
- Rehabilitation performed using corrective, strengthening and neuromuscular control exercises
- Modifying training schedules (e.g. reducing volume, increasing rest durations, etc.)
- Technique modifications for aggravating activities (e.g. running, squatting, jumping, etc.)
- Taping
- Bracing
- Dry needling
- Soft tissue release.
Perhaps the most important aspect of rehabilitation is for you to understand why you are experiencing patellofemoral knee pain and what you can do to help outside of a clinician’s treatment room. Exercises aimed at correcting the muscular weakness and imbalance around the knee and hip, as well as ensuring optimal biomechanical alignment, are the best place to start.
A few tips to help with Patellofemoral Pain
1. Stretch any tight muscles around the hip and knee joints.
Try this stretch to start with:
ITB stretch
In standing, cross one leg behind the other and bend sideways from the hip and extend your arm over your head. You should feel a stretch on the outer hip.
1. While standing, cross the leg to be stretched behind the other leg.
2. Bending sideways from the hip, lean your body away from the leg you are stretching.
3. Take the arm on the side you are stretching, over your head and across to the other side.
4. Push your hips forward to feel a stretch on the outer hip and thigh.
5. Hold this position.
2. Strengthening of the muscles around the hip and knee, in particular the quadriceps.
Try these two strengthening exercises:
Quads strengthening with a squat:
Standing with feet hip-width apart and arms out in front, bend at the hips and knees lowering your buttocks into a half squat. Return to standing.
1. Stand upright with your feet hip-width apart and your arms outstretched in front of you.
2. Bend your knees and hips, leaning your chest forwards lowering your thighs to a 45- 60 degree angle. Make sure you bend from your hips and not your back.
3. Keep your knee in line with your foot, your weight on your heels, your back straight and look ahead. Do not allow your knees to travel in front of your toes.
4. At the bottom of the squat, tense your buttocks, and return to standing upright.
Clams:
Lying on your side with your knees bent, lift and lower your top knee, keeping your lower knee grounded, and your feet together.
1. Lie on your side with your legs together with your hips bent to 45 degrees and your knees bent to 90 degrees.
2. Rest your head on your outstretched arm and bend the top arm, placing your hand in front of your chest for stability.
3. Keeping your feet together, lift the top knee up without rolling your body.
4. Control the movement as you bring the knee back to start.
3. Wear well-fitted and supportive shoes.
Shoes with adequate arch support for running, sports and general everyday use are essential.
If you need further help for Patellofemoral Pain Syndrome or knee pain, please contact us at Move Better for Life or book an appointment online at www.movebetterforlife.physio
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References
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458915/
2. https://www.physio-pedia.com/Patellofemoral_Pain_Syndrome
