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Run Well! PatelloFemoral Pain Syndrome

We are excited to kick off a new series in partnership with Sports Injury Clinic.  www.sportsinjuryclinic.net   This site has been a well used site by me over the last year as I have worked through various injuries.  It provides the right amount of detail about the injury and tips on treatment as well.   And while we hope you don't have the need for the resources, we are pleased to offer articles in tips in the event you are dealing with a running injury.

 

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Patellofemoral pain syndrome is also sometimes called anterior knee pain, or even runners knee. The reason for the variation in terms is due to the rather vague symptoms. This condition is basically an umbrella term, used to describe vague pain at the front of the knee.

Typically, the causes of this pain are also not clear. The general theory is that mal-tracking of the patella causes damage to the articular cartilage lining its underside. Although this damage may be associated with the injury, this cartilage is not innervated (supplied by a nerve) and so cannot cause pain. One possible theory is that the cartilage damage may lead to irritation of the synovial capsule of the joint.

Symptoms of Patellofemoral Pain Syndrome:

As already mentioned, patellofemoral pain syndrome is a very vague condition. However, there are some symptoms that are typically presented:

 Pain surrounding the knee cap at the front of the knee
 Pain is usually described as ‘aching pain’
 Pain comes on gradually
 Pain is often worst when walking down hills or stairs
 Pain often comes on after starting a new activity or increasing training
 There may be clicking or a locking feeling within the knee after longer periods of rest – especially with the knee bent

Mal-tracking of the patella is usually caused by muscle imbalances. Most commonly, the patella moves too far laterally (to the outside). This is usually caused by:

 Tight lateral structures such as the IT band, vastus lateralis muscle (outer quad muscle) and the lateral retinaculum (fibrous connective tissue).
 Weak medial structures – notably the vastus medialis oblique muscle.

Other causative factors include having weak hip abductor muscles (gluteus medius especially) which allows the knee to fall inwards, having particulaly wide hips (pfps is more prevalent in women!) or overpronation at the feet. All of these causes lead to an increased Q angle. This is an angle used to predict biomechanical abnormalities. It is the angle made by the line of the Rectus Femoris muscle and the Patella Tendon. A normal Q angle is between 18 and 22 degrees. An angle above this increases the chance of suffering PFPS. 

PFPS can also occur following knee surgery. This is less common now with the use of arthroscopic (key-hole) techniques for most procedures. However, following surgery, muscle inhibition due to incision of some of the fibres, or prolonged swelling, can cause long-term imbalances as discussed above. The VMO is particularly susceptible to inhibition, further exacerbating the problem.

Treatment

The treatment of patellofemoral pain syndrome focuses on correcting the biomechanical issues:

 Stretch the tight lateral structures
 Sports massage can help with loosening the ITB and lateral quads.
 Strengthen the medial quads with emphasis on VMO
 Strengthen the hip abductor muscles
 Correct overpronation if necessary

Whilst rehabilitating this injury, rest should be taken from any activities which cause pain. If pain is present during day-to-day duties, then a taping technique or knee brace  may be used to reduce lateral tracking of the knee cap.

The IT band is usually tight in cases of PFPS. Stretching this structure can be difficult, but there are a number of stretching techniques which can be used, the difficulty comes in finding one which works for you! Here are two of our favorites:

 Place the leg you want to stretch behind the other one.
 Keep the knee straight and push the hips out towards the affected side.
 Hold for 30 seconds, repeat 3-5 times and do this at least three times a day.
 Never bounce when stretching, always ease into it gently and try to relax.

Alternatively:
 Sit on the floor with the uninvolved leg straight
 Bend the leg you wish the stretch and place the foot on the floor, the other side of the uninvolved knee
 Pull the knee of the involved leg across your body until your can feel a stretch on the outer thigh or hip

We always advise seeking professional treatment in order to return to fitness as soon as possible and free from pain! A professional sports injury specialist may also:

 Tape the knee for you
 Apply sports massage therapy
 Perform some partner stretches with you
 Provide a full rehabilitation program
 Prescribe orthotics or recommend someone who can

For more information on PatelloFemoral Pain Syndrome, including taping techniques, exercises and a sports massage demonstration, please visit:  www.sportsinjuryclinic.net

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Comments

Janelle

As a physical therapist I would also recommend that addressing lateral hip weakness be a part of the treatment for patella femoral syndrome. Numerous research articles have identified lateral hip weakness (specifically the glute medius) as being highly related to anterior knee pain.

For pictures of exercises for treatment of patella related pain visit:

http://www.joint-pain-solutions.com/knee-cap-pain.html

~JTrempe PT, ATC

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Knee pain can severely limit our running. I hope you recover fast and go back to running.

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Indeed, those are the symptoms of PatelloFemoral Pain. The treatment is not done overnight as there could be weekly sessions that can run through months. But one will recover.

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As mentioned above, quadriceps strengthening and iliotibial band stretching are recommended for patellofemoral pain. Although one can manage PT on their own, one also needs to adhere to the therapist's home program.

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