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Patellofemoral Pain

How to prevent and treat patellofemoral pain syndrome

The Dublin half-marathon is fast approaching (September 19th) and with so many runners training, we wanted to provide some helpful tips on prevention and treatment of patellofemoral pain. Patellofemoral pain, or to the layman "knee pain" is the most common knee related complaint from young and the old alike.
What is Patellofemoral pain?
Patellofemoral pain is the term for pain behind the kneecap. It gets its name because the pain ocurrs at the joint where the patella (kneecap) meets the femur (thigh bone). Excessive joint pressure and poor kneecap alignment can affect the joint surface in the long-term causing pain.
What is the Cause?
When the knee bends your kneecap normally glides easily in the femoral groove, but if the kneecap doesn't glide normally or rubs to one side of the femur it can cause pressure and pain. This can lead to pain, joint inflammation and could degrade the patella joint surface. Kneecap pain affects 25% of people at some point in their lifetime. Participants in sports such as running, tennis, netball, football, volleyball, basketball, skiing and other sports experience patellofemoral pain most often.
The main causes are:
  • Muscle Imbalance:
    An imbalance exists between the two thigh muscles, the Vastus Lateralis (VL) which pulls the patella up and out and the Vastus Medialis Obliquus (VMO) which pulls the patella up and in. Such an imbalance is often due to a knee injury, post-surgery recovery, swelling, or disuse. Patellofemoral pain is most common in youth, when the bones are growing faster than the muscles.
  • Poor Mechanics:
    Poor body mechanics such as slouched posture, flat feet, or weak hip muscles can contribute to knee pain. Poor bio-mechanics can allow the knee to twist abnormally, which when repeated can be very detrimental. 
Symptoms
The symptoms of patellofemoral pain can be hard to detect as pain onset is usually gradual. Symptoms are most often noticed during weight-bearing or jarring activities. Activities such as climbing stairs, squatting, kneeling, hopping, and running can be especially painful. One frequent symptom is pain during a sustained knee bend, felt while sitting in a chair. 
Treatment
Physiotherapy intervention has proven to be massively effective. The majority of patients report being pain free after 6 weeks. If patellofemoral pain is prolonged without treatment surgery might be necessary to avoid arthritis in the knee.
Treatment occurs in several steps:
  1. Reduce pain and inflammation: active rest, icing, and protective kinesio taping can help.
  2. Regain full range of motion
  3. Stretch and restore muscle strength
  4. Normalise muscle balance and bio-mechanics
  5. Restore speed, power, and agility
  6. Return to regular activity/sport
Many athletes are prone to patellofemoral pain syndrome; there is no one specific sport that is primarily affected. Yet we usually think about sports that involve running, jumping and cutting because they can contribute to patellofemoral pain syndrome due to the mechanics of the knee - the way the patella tracks - Dr. Scuderi
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