Patellofemoral Pain Syndrome: Causes, Symptoms, and Treatment
Patellofemoral Pain Syndrome (anterior knee pain) also known as "runner's knee" or "jumper's knee" is one of the most commonly treated condition in orthopedic and musculoskeletal care practices. It causes pain around and under the kneecap. The pain and stiffness can make it difficult to climb stairs, squat down, and perform other everyday activities. Almost anyone can get it, but it particularly affects runners, cyclists and hikers, and also office workers or anyone else who sits for a living.
While patellofemoral syndrome can cause symptoms that range from uncomfortable to unbearable pain, the condition can usually be treated conservatively , such as changes in activity levels or a therapeutic exercise program.
The patellofemoral joint comprises the patella and the femoral trochlea. The patella acts as a lever and also increases the moment arm of the patellofemoral joint, the quadriceps and patellar tendons.
Stability of the patellofemoral joint involves dynamic and static stabilizers (muscles) which control movement of the patella within the trochlea, referred to as “patellar tracking.” Patellar tracking can be altered by imbalances in these stabilizing forces affecting the distribution of forces along the patellofemoral articular surface, the patellar and quadriceps tendons, and the adjacent soft tissues. Abnormalities of patellar tracking must be understood to appreciate the possible causes of PFPS and to determine the focus of treatment.
The exact cause of patellofemoral pain syndrome is unknown. Several factors may contribute to the development of PFPS, including:
Overuse: Running or jumping sports puts repetitive stress on your knee joint, which can cause irritation under the kneecap, specially if done without proper training.
Muscular weakness: Weakness around the muscles of your hips and knees don't keep your kneecap properly aligned which causes patellar maltracking.
Flat feet (excessive foot pronation): Patients with little or no arch in the foot are also likely candidates for patellofemoral pain.
Improper equipment use or sports training techniques: Improper training and form during exercises causes excessive loading on the knee. One common factor is inward movement of the knee during a squat, it has been found to be associated with patellofemoral pain.
Changes to footwear - Wearing improper footwear can change the stress placed on your knees, leading to injury and pain.
Signs and Symptoms
Many people experience a dull, aching pain in the front of the affected knee and symptoms usually get worse gradually and with activity. Your symptoms may also include:
Pain during activities that bend the knee, including squatting or climbing stairs
Pain after sitting for extended periods of time with your knees bent
Crackling or popping sounds in your knee when standing up or climbing stairs
Pain that increases with changes to your usual playing surface, sports equipment or activity intensity
Management & Treatment
Preventive Management & Conservative Treatment
Patellofemoral pain syndrome can usually be effectively treated with a non-operative treatment program. It can take the knee six weeks or more to show improvement once treatment begins; this is often the same length of time the pain has been present. The following options are typically used in a conservative treatment program:
RICE method may ease symptoms. RICE means Rest, Ice, Compression and Elevation.
Rest: Avoid putting any weight on the knee.
Ice: Do not apply ice directly to your knee. Instead, apply cold packs wrapped
in a towel for 12-15 minutes at a time, several times each day.
Compression: Using an elastic bandage, lightly wrap your knee while leaving
an opening over your kneecap. Make sure the bandage is not wrapped too
tightly. Be sure the bandage does not cause more pain.
Elevation: Rest with your knee higher than your heart.
Proper footwear: Supportive and comfortable shoes help take pressure off the knee joint by promoting proper leg alignment and balance.
Lose excess pounds: If you're overweight, losing weight will help reduce pressure on your knees.
Warm up: Before running or other exercise, warm up with five minutes to prepare your muscles before the activity.
Strength Exercise: Strong quadriceps and hip abductor muscles help keep the knee balanced during activity, but avoid deep squatting during your weight training
Stretch: Promote flexibility with gentle stretching exercises.
Increase intensity gradually: Avoid sudden changes in the intensity of your workouts.
Your treatment depends on the severity of your symptoms. Going to a Physical Therapist is beneficial to alleviate the pain, improve muscle activity and flexibility to help you get back to your activities of daily living.
Rehabilitation exercises. Specific exercises can strengthen the muscles that support your knees and control limb alignment, such as your quadriceps, hamstrings and the muscles around your hips, especially hip abductors. Correcting inward movement of the knee during squatting is a primary goal.
Supportive braces. Knee braces or arch supports may help improve pain.
Taping. Your physical therapist may show you how to tape your knee to reduce pain and enhance your ability to exercise.
Ice. Icing your knee after exercise might be helpful.
Knee-friendly sports. During your recovery, you may want to restrict yourself to low-impact activities that are easier on the knees — such as bicycling and swimming or water running.
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Brunnstrom's Clinical Kinesiology by P. Houglum & D. Bertoti 2012