Patellofemoral Pain Syndrome

The patellofemoral joint is the “joint” between the femur (thigh bone) and the patella (kneecap). It is a common area causing pain in different age groups. As the knee bends and straightens, the patella slides within the groove on the femur. The patella moves in many directions within this groove to provide efficient and frictionless movement up and down, side-to-side, rotation and tilting.

Various factors can lead to patellofemoral pain including the following:

• Overuse: the repetitive bending and straightening of the knee that occurs in sports and activities such as running or jumping, may lead to the disorder because of the increased pressure between the patella and femur when the knee is bent. Frequent bending motions, especially on the weighted leg, can irritate the patella and cause a bone bruise to occur. In some cases, the pain is caused by a weakening of the articular cartilage and/or swelling within the joint.
• Alignment: The quadriceps, the group of muscles at the front of your thigh between the hip and the knee, is thought to affect patella tracking/movement. People with larger than normal Q angle (the angle formed between the quadriceps and femur) may be more susceptible to patellofemoral pain because the patella has a tendency to track more laterally (to the outside of the knee joint).
• Muscular weakness: A weakness or strength imbalance of the quadriceps muscles can alter the tracking of the patella.
• Muscle tightness: Tight muscles in the knee and hip regions can also affect patellar tracking.
• Flat feet (excessive rolling inward of foot): People with little or no arch in the foot are also likely to get patellofemoral pain. As the foot rolls inward, the leg compensates by rotating inward. This would disturb the normal mechanics of the patellofemoral joint.
• A decrease in patellar mobility: the kneecap tightens, losing its normal ability to move in many directions.

Treatment depends on the assessment findings by your physiotherapist. Multiple structures may need to be addressed in order to promote better kneecap alignment and movement. A treatment regime may involve correcting muscle imbalances, increasing mobility of the patellofemoral joint and correcting foot biomechanics. It is also important to reduce the swelling in the knee, by gentle knee movements to pump swelling away, ice (15 minutes after exercise/activity), compression (in the form of bandage) and elevation (resting leg straight above the level of the heart). A regular active exercise and stretching program not only helps correct this condition but will also prevent recurrence.

The goal of rehabilitation is to return you to your sport or activity as soon as possible. Everyone recovers from injury at a different rate but in general, the longer you have symptoms before you start treatment, the longer it will take to get better.

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