Knee Pain Series-Part 2: Patellofemoral Pain Syndrome

Patellofemoral pain syndrome is used to describe pain under or around the patella (kneecap).  It’s exact cause is not known but it can be the result of a number of factors.

A likely cause is abnormal tracking of the patella.  Normally, the patella glides forwards and back in a straight line along the groove of the femur (thigh bone), but sometimes the patella can move off track, causing stress on its underside. 

Symptoms

  • Pain under the kneecap or within the joint
  • Pain when seated for prolonged periods
  • Clicking or crunching in the joint
  • Pain when going downhill or downstairs

Causes

  • Muscular imbalance in the hips, legs or feet, most commonly in the quadriceps (front of the thighs) with the Vastus Lateralis on the outside of the leg being stronger than the Vastus Medialis on the inside of the leg and ‘pulling’ the kneecap off track. 
  • Misalignment of the knee-joint
  • Tight muscles, particularly on the lateral side of the leg
  • Biomechanical problems

Treatment

  • Daily strengthening exercises (see below) to build strength, particularly Vastus Medialis and Vastus Medialis Oblique (VMO), the lower, oblique fibres of Vastus Medialis
  • Sports massage to loosen tight structures
  • Orthotics to correct poor mechanics of the feet if present
  • Rest from pain causing activity
  • Avoid squatting, jumping, running and going up and down stairs

Strengthening exercises

1.  Sit on the floor with a rolled up towel under your knees.  Rotate your leg so your foot is turned out to about 45 degrees.  Place your fingers on the VMO and contract for 30 seconds, straightening the leg.  Try to contract the VMO before the other quads take over.  Repeat 5 times.

2.  Stand with your back against a wall and your legs not quite flexed to 90 degrees.  Place a football or object of a similar size and weight between your knees and hold for 30 seconds.  Repeat 5 times.

3.  Quadriceps stretch.  Standing, bend one leg and take hold of your foot with your heel towards your bottom.  Keep the supporting knee slightly bent, knees hip width apart and back straight until you feel a stretch at the front of the thigh.  Hold for 15-20 seconds.

4.  ITB stretch.  Cross the injured leg behind the good leg, taking it as far as you can comfortably.  Push your hips to the side of the injured leg until you feel the stretch in your hip/outer thigh and hold for 15-20 seconds.

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