Patella-Femoral Pain Syndrome
Patella-Femoral Pain Syndrome
Pain at the front of the knee and under the kneecap is a frequent complaint we see at Sports and Spinal Physio – this discomfort can be due to conditions such as fat pad impingement, patellar tendinitis, tendinopathy or more commonly Patello-femoral joint syndrome. In this article we will tell you more about this knee condition that affects many through our life.
The typical Patello-femoral joint syndrome patient presents with a history of a generalized ache at the front of the knee, placing the palm of the hand directly over the kneecap to indicate the region of pain. The pain is often aggravated by running (especially downhill), stairs and sitting for prolonged periods with the knee bent – this is termed a positive “theatre sign” or “movie sign” with patients preferring to sit in the aisle seats to allow them to keep the knee extended during the performance.
Effective management of Patello-femoral joint syndrome starts with a full physiotherapy assessment to identify the problem and outline the best course of treatment to get the patient back to full training and activities as soon as possible. The initial stage of treatment (as with most overuse injuries) is to actively control pain and inflammation – this is best achieved with a combination of ice, rest from aggravating activities, anti inflammatory medication and the use of Patello-femoral taping to reduce pressure on the injured joint.
An important component of the rehabilitation process is the need for an effective strengthening program to restore pre injury function. The majority of exercises should be performed pain free with close attention being paid to any post exercise pain and especially increased pain the morning after a rehabilitation session – the need for appropriate strengthening must be balanced with possible aggravation of symptoms.
The exact exercises chosen will depend on the severity of symptoms and will e guided by your physiotherapist but the majority of programs initially focus on isolating the Vastus Medialis Oblique (the small muscle on the inside of the knee) to contract prior to the activation of the rest of the quadriceps group. This is sometimes done using an EMG machine which measures electrical activity in the muscle. Alignment of the leg and foot are very important when treating this condition and often small squats with emphasis on knee position are taught.
Other important components of a successful Patello-femoral joint syndrome rehabilitation program will include specific stretching of the iliotibial band, hamstrings, calves and quadriceps, as well as effective (and sometimes uncomfortable) deep tissue massage of the ITB – this can also be augmented by the patient using a foam roller to “self massage” the lateral structures of the knee.
Many patients with Patello-femoral joint syndrome have issues relating to subtalar pronation (sometimes referred to as flat feet) which can act to increase internal rotation of the lower limb contributing to alignment issues – these patients are often best treated with an individually moulded orthotic device placed in their shoes to assist in controlling foot function.
While patella femoral pain is a very common injury it is also very treatable and with the right combination of rehabilitation exercises, stretching and biomechanical correction the sufferer will be back to sport in next to no time.