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Patellofemoral Pain Syndrome

Patellofemoral pain (runner's knee) is the most common overuse injury among runners. It is the term used by medical practitioners when pain occurs at the front of the knee around the patella (kneecap). The pain can get worse when you're active or when you sit for a long time. Patellofemoral pain is a common problem which may occur in one knee only, or can sometimes be felt in both. An increase in pain is usually noted when going up and down stairs, and crepitus (grinding/cracking) is often associated with any squatting movement.

What causes it?

patellofemoral painThe exact cause of patellofemoral pain is unknown. The term patellofemoral pain is used as an umbrella to describe pain around the kneecap that can be caused by a number of different factors. It is thought to be primarily due to a soft tissue disorder. The cause of pain and dysfunction often results from either abnormal forces or prolonged repetitive compressive or shearing forces (such as during running or jumping) on the patellofemoral joint. This can result in thinning and softening of the articular cartilage under the patella and/or on the femur that connects to the patella. Other less common causes of Patellofemoral Pain Syndrome are fractures, internal knee derangement, osteoarthritis of the knee and bony tumours in or around the knee.

Specific populations at high risk of Patellofemoral Pain Syndrome include runners, basketball players, young athletes and females. Unless there is an underlying pathology in the knee, swelling is usually minimal.

Common causes that can result in Patellofemoral Pain are;

  • Increasing training and particular sports place extra strain on the patella.
  • Overuse of the knee from sport along with an alignment problem of the knee may be the most common cause for patellofemoral pain.
  • Atypical alignment of the knee. Instead of gliding over the femur the patella may rub on it. This can be a result of a developmental mal-alignment, or an imbalance of the muscles, causing the patella to be pulled harder on one side.
  • Flat feet can cause the foot to roll inwards, therefore affecting the alignment of the knees and causing the patella to be pulled sideways. 

How is patellofemoral pain diagnosed?

Normally the diagnosis is made by your doctor or physical therapist by performing a physical examination.

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. If you want to keep exercising, try swimming or another low-impact activity, such as the Cross-trainer. As your knees feel better, you can slowly go back to your normal sports. But do this gradually, and increase the time spent on the activity by 20% a week.
  • Ice your knees for 10 to 15 minutes after activity. This can ease the pain and speed up healing.
  • Painkillers - Paracetamol and/or anti-inflammatory painkillers such as ibuprofen can help, however consult your GP for further advice.
  • Seek advice from a musculoskeletal/manual therapist to speed your recovery.

Seeking treatment to address the problem can be beneficial long-term. Underlying causes can be addressed by hands-on techniques as well as exercise programmes:

  • Manual therapies such as Chiropractic, Osteopathy or Physiotherapy aim to improve the strength of the muscles around the knee and help to correct problems with alignment and muscle imbalance. Your manual therapist can give advice tailored to your individual situation.
  • A podiatry assessment may be necessary to determine the need for orthotics to correct faulty walking patterns.
  • Taping of the patella to alter the alignment or the way the patella moves. Our Chiropractors, Osteopaths and Physiotherapists can all offer taping treatment.
  • Surgery is rarely used for patellofemoral pain. However, it may be helpful in certain situations.

Most of all, be patient! Patellofemoral pain can be hard to treat, and your knees won't get better overnight. Some people are lucky and get better quickly. But it might take six weeks or even longer for your knee pain to resolve. Keep exercising to get better, using activities that put your knee under the least amount of stress possible, whilst still maintaining cardiovascular fitness.

Contributing Authors:
Shelley Doole, DC MChiro

References

Aminaka N, Gribble PA; Patellar taping, patellofemoral pain syndrome, lower extremity kinematics, and dynamic postural control. J Athl Train. 2008 Jan-Mar;43(1):21-8. [abstract]

Heintjes E, Berger MY, Bierma-Zeinstra SM, et al; Exercise therapy for patellofemoral pain syndrome. Cochrane Database Syst Rev. 2003;(4):CD003472. [abstract]

Heintjes E, Berger MY, Bierma-Zeinstra SM, et al; Pharmacotherapy for patellofemoral pain syndrome. Cochrane Database Syst Rev. 2004;(3):CD003470. [abstract]

Labotz M. Patellofemoral syndrome. The physician and sportsmedicine July 2004.
Potter JP et al, Patellofemoral Syndrome, Medscape, Oct 2011

Tom Plamondon. Special tests in the clinical examination of patellofemoral syndrome. Doctors Lounge Website. Available at: http://www.doctorslounge.com/index.php/articles/page/287