Patellofemoral Pain Syndrome

OVERVIEW

Knee pain is a common problem for both athletes and non-athletes. For someone who has not been involved in a traumatic injury, a condition called patellofemoral pain syndrome (PFPS) may be the problem. PFPS goes by several other names, including chondromalacia patella, patellar pain syndrome, and anterior knee pain.

PFPS accounts for approximately ¼ of knee related injuries. Unfortunately it may become a chronic problem if not treated correctly. Another ¼ of people having this type of knee pain may still have problems up to 20 yrs later after the initial onset. Females suffer from this condition more than males.

The pain presents frequently as a vague or diffuse pain, felt in the patella (kneecap) area, or on either side of it. Aggravating positions or activities include prolonged sitting with knees flexed, such as sitting in class or during car rides, going up or down stairs, squatting, kneeling, and running or exercising.

The pain is believed to be a result of malalignment, poor tracking, or chronic overloading of the patella onto the joint surface beneath it as the knee bends and straightens. These abnormal contact pressures between the kneecap and joint surfaces over time may result in degeneration and long term damage of the underlying cartilage.

Possible contributing factors to patellofemoral pain can be due to a single or multiple factors. These include being overweight, muscle weakness in the quadriceps and hip muscles, muscle and other soft tissue tightness, and structural abnormalities such as excessive foot pronation and “knock knees”, to name a few.

TREATMENT

Following are possible beneficial considerations, tips, and exercises for patellofemoral pain

Avoidance of aggravating activities

This includes avoiding stairs, squatting, kneeling, sitting cross-legged or such as in tight seats in the classroom, long car rides, biking especially with a low seat, and performing exercises that require deep knee bends. A common sense rule is, “If it hurts, don’t do it.”

Strengthening Exercises

Having strong quadriceps muscles will help stabilize the knee and improve proper tracking. Having strong muscles in the hip and pelvis, especially the gluteal muscles, will make it easier to maintain proper alignment of the thigh in relation to the lower leg and foot. Strengthening exercise examples follow:

Beginning Exercises (for someone more limited functionally because of pain):

 

Leg Lifts - anterior thigh muscles
Make sure the leg remains completely straight when raising it.

 

Leg lifts-lateral thigh and gluteal muscles
Keep the leg in alignment with the body. Doing this exercise against a wall helps to ensure good form.

 

Leg Lifts - inner thigh muscles
If this bothers the bent knee, place the foot behind the straightened leg.

More Aggressive Strengthening Exercises (for someone able to tolerate them):

Step Ups

Step up and down on a 6 to 7 inch step, making sure the kneecap does not move in front of the toes.

Progress gradually to 3 sets of 10 reps.

   start position

   lift

   return/end

Hip Hiking

Stand on a step with the other leg dangling and the pelvis level. Slowly drop the opposite leg below the level of the step while keeping the stance leg straight. Raise the pelvis to level again. Perform until the stance leg is fatigued. Use your hands for balance as needed.

Repeat as tolerated.

   start position

   lift

   return/end

Clamshell

Keep knees and ankles together. Raise the top knee while keeping the ankles together. Lower knee to resting position.

Progress to 3 sets of 10 reps.

Wall Slides

Slide up and down a wall, making sure the kneecaps do not move in front of the toes. Do not drop the hips so low that pain is felt in the knees.

Progress gradually to 3 sets of 10 reps.

Single Leg Stand

Stand on the outside leg keeping the pelvis stable. Push against the wall with the opposite knee and hold for 10+ seconds if possible.

Perform till the stance leg is fatigued. Repeat as tolerated.

Knee Extensions

Begin with both feet dangling. Straighten the leg fully and hold for a second, then slowly lower to the resting position.

Progress to 3 sets of 10 reps.

   start position

   raise foot

   return/end

Tip: Strengthening should be done with no pain. If you have pain while doing exercises, make sure that you have proper alignment of your leg. Proper alignment is when the femur or thigh bone is line with the 2nd toe, especially when bending the knee.

Flexibility Exercises

Stretching out the leg muscles will help in proper tracking of the patella as the knee bends and straightens.

Hold these first three stretches for 30 seconds.

Hip Flexor Stretch

Quad Stretch

Hamstrings Stretch

ITB (Foam Roller) Stretch

Roll along the length of the outside thigh, staying off the bones in the hip and knee, for 30 seconds if tolerated. You may use a hard plastic water bottle wrapped with a towel instead of a foam roll. This exercise may be especially painful at first but should become less painful after several days.

Providing Support for Flat Feet

Research has shown that fallen arches/flat feet may lead to knee pain since this can alter patellar tracking. Providing support in the arch and/or heel may improve knee alignment and patellar tracking, thereby reducing knee pain. The devices providing support range from less expensive, over the counter inserts to expensive custom made orthoses fabricated by a podiatrist or other trained health care professional or designated lab. It is advisable to purchase the less expensive over-the-counter inserts at better shoe stores than to buy the cheapest ones available since the former inserts generally are more supportive. Wear time for new arch supports should be gradually increased each day so that the foot can adapt to them.

References: