Patellofemoral Pain Syndrome

A quick introduction on the Patella

Commonly called the “knee cap” its function is to create a more efficient pully system when straightening your lower leg; this is known as knee extension. An example of knee extension is the forward movement of your lower leg when kicking a soccer ball.

The patella tracks in a grove in the lower portion of your thigh bone (femur) – this association between the patella and its groove in your thigh is known as the patellofemoral joint. The “tracking” of the patella in this groove requires a balance of forces to keep it centred in the groove – an imbalance can lead to pain or altered function that may lead to knee or other pain in this area.

What is it?

Patellofemoral Pain Syndrome (PFPS) is an overuse disorder that often presents as poorly localised pain around, behind or at the front of the patella. It can give an ache or a sharp pain and at times can lead to the knee “giving way” or buckling.

It is the most common cause of knee pain accounting for 25-40% of all knee problems seen in sports injury clinics. Women are more commonly affected than men at a ratio of almost 2:1.

How does it come about?

Due to conflicting results and a lack of reproducibility, no consensus exists in the literature regarding how exactly it comes about, or what factors/activities are most responsible for causing this pain.

Potential Risk factors:

There are several proposed risk factors that may initiate or lead to an increased risk in developing PFPs. They include overuse, malalignment, trauma, a higher BMI and a high training regime.

Overuse:

Knee pain from PFPs worsens with squatting, running, prolonged sitting or when ascending/descending steps.

Malalignment:

Factors influencing malalignment:

1. Static: leg length discrepancies, foot/toe morphology, hamstrings and tight hip muscles, abnormal patella mobility, angular/rotational deformities of the lower leg.
2. Dynamic: muscle weakness/imbalance, hip weaknesses, abnormal ground reaction forces, excessive foot pronation, insufficient foot pronation.

Treatment Regime

With so many factors influencing PFPS it is imperative you get assessed by a qualified chiropractor or therapist who understands the biomechanics of your body. Our goal is to first decrease pain and then improve tracking and alignment. Getting a correct assessment and treatment will help you to understand where the issue has come from and decrease the pain and dysfunction longevity. Remember in some cases the longer you leave an issue the longer the recovery time; you have to first break the pain cycle and then re-train the dysfunction into proper tracking and alignment.

Treatment for this issue from a chiropractor may include: muscle release work; adjustments where needed, taping, dry-needling and rehabilitation.

Some Self-Help Tips:

• Avoid pain activities.
  • Decrease volume of training or if really bad then stop all together.
  • Decrease hills/stairs etc. Can use bicycle, swim or other so long as no pain.
• Ice
• Barefoot running/minimalist shoes = can help decrease peak patellofemoral joint stress by 12% (mainly barefoot running).
• Short term anti-inflammatory use
• If the pain decreases within the first week then progress onto:
  • Hamstring and quadriceps stretches
  • Strengthening your hips (closed chain exercises with a focus on core and hip stability)
  • Quadriceps strengthening.
• Get assessed and treated by a chiropractor!

Other potential methods:

Foot orthoses, glycoaminoglycan and corticosteroids have limited evidence in helping.

Written by Todd Daniels
Chiropractor