Patellofemoral Pain Syndrome
What is Patellofemoral Pain Syndrome?
Patellofemoral Pain Syndrome is a common cause of pain around the knee cap, that is sometimes referred to as ‘Anterior Knee Pain'.When the knee bends or straightens, the knee cap glides in a special groove on the thigh bone called the ‘Patellofemoral groove', controlled by the quadriceps (thigh) muscles. However, for several reasons it may stray from this path (usually towards the outside of the knee). This is called Patellofemoral Maltracking and produces abnormal stresses on the under-surface of the patella that can cause knee cap pain.
The knee joint is made up of three bones:
- the Femur (thigh bone),
- Tibia (shin bone)
- and Patella (kneecap).
The Patella is wrapped inside a Quadriceps tendon that connects the thigh muscles (Quadriceps) to the shin. When the knee bends, or straightens, the knee cap normally glides in a special groove on the thigh bone called the Patellofemoral groove.
With Patellofemoral maltracking, abnormal stresses are put on the under-surface of the knee cap that can cause pain. This is similar to having the front tyre of a car slightly out of alignment, leading to abnormal wear. If allowed to progress, these stresses can cause damage to the articular cartilage on the knee cap (a condition called Chondromalacia Patella) and femur.
Patellofemoral maltracking is one of the most common causes of knee pain and can be caused by numerous factors:
- Tightness in certain structures. (e.g. calf and hamstring muscles).
- Weakness or incoordination in muscles that should help maintain normal patella tracking.
- Altered hip, knee or foot posture.
- Anatomic variations such as a shallow Patellofemoral groove.
Patellofemoral Pain Syndrome Signs & Symptoms
The most common symptom of Patellofemoral maltracking is pain at the front of the knee that can occur while ascending or, more often, descending stairs and whilst running. Pain can also result from prolonged sitting and some people may experience instability (this can involve a sensation of insecurity or actual giving way of the knee) or locking of the knee.
What can I do to help my knee get better and hurt less?
- Take a break from physical activity that causes a lot of pounding on your legs, such as running, volleyball or basketball. If you want to keep exercising, try swimming or another low-impact activity. You may want to try working out on nonimpact elliptical trainers, which are popular at gyms. Because these machines support your body weight, they put less stress on your knees. As your knees feel better, you can go back to your normal sports. But do this slowly, increasing the amount of time you do the sports activity a little at a time.
- The exercises shown in this handout can help strengthen your muscles and relieve your pain. Each exercise should take a few minutes. Doing them twice a day is a good start. Your doctor will tell you which exercises are right for you. The first 2 are usually the most important ones. These 2 exercises make your front thigh muscles ("quads") stronger. This is important because your quad muscles control the movement of your kneecap.
- Talk to your doctor about footwear. It may help to bring your shoes in for the doctor to see. Proper walking or running shoes can help knee pain. Even a simple arch support insert from a shoe store can be helpful. This insert is less expensive than a custom-made support or brace.
- Ice your knees for 10 to 20 minutes after activity. This can ease the pain and speed up healing. To keep your hands free, use an elastic wrap to hold the ice pack in place. A medicine such as ibuprofen (one brand name: Motrin) may also help relieve your pain, but talk to your doctor before you take this medicine.
If the pain does not stop after 3 or 4 weeks, call your doctor
Patellofemoral Pain Syndrome Prevention
There are a number of causes of Patellofemoral maltracking, which are different in each individual. A specific assessment and treatment programme should be formulated by a physiotherapist in order to address individual issues. In terms of preventing symptoms, many people find that a Knee Brace can be effective in preventing Patellofemoral Pain Syndrome.
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