Patellafemoral pain syndrome is a patellar tracking problem and is a term used to describe pain experienced at the knee involving the patellofemoral joint. The knee is a hinge joint and moves optimally in one plane of motion. The main joint of the knee is the tibiofemoral joint; as the knee flexes and extends the tibia moves along the femur, cushioned by the medial and lateral meniscus. The second joint of the knee is known as the patellofemoral joint which consists of the knee cap and the femur. As the knee flexes and extends the patella glides along the femur within the groove at the end of the femur. When movement at the patellofemoral joint is altered pain can arise due to poor mechanics. Patellofemoral pain syndrome is common in runners and athletes whose sports involved running, jumping, medial/lateral movements and twisting/turning.
Signs of patellofemoral pain syndrome:
•Dull, aching pain in the knee
•Anterior or lateral knee pain or pain behind the patella
•Clicking or popping in the knee
•Feeling like the knee is giving out or buckling
•Pain with walking/running, going up and down stairs, squatting
What is the cause of patellofemoral pain syndrome?
The main control of the knee comes from the hip. The hip muscles are responsible for movement of the femur, and when it comes to the knee they are necessary to control rotation of the femur at the hip to prevent excessive rotation at the knee. With patellofemoral pain syndrome there is often a dysfunction of the hip external rotators and hip abductors, which leads to hip internal rotation and adduction of the leg. At the knee, this causes a medial collapse, or valgus force, that stresses the inside of the knee and compresses the outside of the knee. This altered position of the femur changes the position of the patella and how it glides in the joint. It also changes how the muscles surrounding the knee work. With the hip internally rotated and the leg adducted, the lateral quadriceps muscle is overactive, creating a greater pull on the patella toward the outside of the knee. Consequently, the medial quadriceps muscle is underactive, unable to balance the force produced by the lateral quadriceps. When the patella glides improperly along the femur it grinds along the bone, producing pain. The pain experienced can also be coming from the lateral quadriceps or the iliotibial band as the work to control the forces through the knee. Additionally, poor foot mechanics can also be a contributing factor to PFPS. Studies show that people with this condition show greater rear foot eversion and overpronation on the painful side when walking and running. This leads to greater valgus force at the knee which increases the joint reaction force at the patellofemoral joint.
What is Iliotibial Band Syndrome?
Iliotibial band syndrome is related to patellofemoral pain syndrome as it can directly affect the knee. It is an overuse condition due to repetitive flexion and extension of the knee with the femur in an improper position. When the hip is in excessive adduction and internal rotation it causes increased friction where the iliotibal band inserts around the knee when bending and straightening the knee. This is most commonly seen in people that run and cycle more extensively.
Can physical therapy help?
Patellofemoral pain syndrome is pathomechanical not pathoanatomical, meaning it is due to a biomehcanical or movement dysfunction, not an anatomical or structural dysfunction. Physical therapy will help to correct improper movement patterns and muscle imbalances to reduce stress on the patellofemoral joint and improve control at the hips. Strengthening, motor control, flexibility, core work, proprioception, balance, gait retraining and manual therapy are utilized to treat patellofemoral pain syndrome. F.I.T. physical therapy will work with you to reduce your pain and get you back to your activities quickly while implementing a plan to address your specific dysfunctions and goals for rehab.
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The doctors at F.I.T. Muscle & Joint Clinic in Overland Park & Shawnee, Kansas and Lees Summit, Missouri are here to help lessen and relieve your pain. Do not hesitate; contact us today for leading evidence-based assessments and treatments for your musculoskeletal pain and dysfunction.