Patellofemoral Pain Syndrome

Description:

The patella, or kneecap, is a large sesamoid bone that is embedded in the tendon that passes in front of the knee. Patellofemoral pain syndrome (PFPS) is the most common presentation in most sports medicine practices. It is characterized by pain in and around the patella (knee cap). Pain sometimes intensifies with prolonged sitting (theatre sign) or with stair/hill descent.

Common Signs and Symptoms:

• Pain associated with running, prolonged sitting, and/or stair or hill descent,
• Pain will generally increase throughout the course of activity,
• Vague and diffuse pain in and around the patella, and/or
• Occasional “clicking” and giving way episodes.

Causes:

• Patellar malalignment secondary to:
  • Genu valgum (“knocked knee”),
  • Unhealthy pronation and knee internal rotation, and
  • Quadriceps weakness.
• Soft tissue inflexibility:
  • Muscular: calf muscles and hamstrings, and
  • Lateral structures: Lateral quadriceps and iliotibial band.
• Muscle dysfunction:
  • Medial (inside) quadriceps, and
  • Hip musculature.
• Training issues:
  • Distance running, and
  • Hill and stair descent.
• Excessive mechanical loading and resulting physiological response.

Preventative Measures:

• Maintaining appropriate conditioning:
  • Calf muscle flexibility,
  • Muscular strength and endurance, and
  • Cardiovascular fitness.
• Proper footwear:
  • Replace running shoes every 500-800 kilometers.

Management:

• Reduction of pain and inflammation:
  • Rest from aggravating activity,
  • Icing,
  • Non-steroid anti-inflammatory interventions,
  • Physiotherapy modalities, i.e. ultrasound, laser and electrical stimulation, and
  • Taping.
• Muscle training:
  • Muscle strengthening of quadriceps (inside patella) musculature (gluteus medius).
• Stretching:
  • Lateral structures of the knee: iliotibial band and retinaculum, and
  • Quadriceps, hamstrings and calf muscles.
• Massage:
  • Manual release of tight structures such as the iliotibial band and hamstrings.
• Custom foot orthoses, patellar stabilizing braces and footwear prescription.