What Is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome, also known as runner’s knee, is pain felt between the patella (kneecap) and femur (thigh bone), it is most commonly caused by overuse, or too much pressure being placed on your kneecap. This syndrome is often caused by:

• running 
• jogging 
• cycling
• walking up & down hills or stairs
• incorrect squatting or lunging
• incorrect bending techniques 
• poor biomechanics from muscle imbalances around the hip, pelvis, or ankle 
• joint stiffness in the hip or ankle

Why does this occur?

Knees are very complicated joints, with many different parts and joints: cartilage, menisci, patella, ligaments, muscles, tendons and the connective tissue. There is a lot of potential for something to go wrong as everything is interconnected and one minor problem with one part of the knee can cause lasting damages to other parts.

When there is knee pain with no associated swelling, it is likely due to a muscle imbalance than damage to the knee itself. This is the case with the majority of knee pain that occurs with running. This can cause a number of common diagnoses for knee pain caused by muscle imbalances. 

IT Band Friction Syndrome – Imbalance in the muscle puts excessive tension on the patella tendon or more commonly on a structure called the iliotibial (IT) band. The IT band spans from the hip to the knee along the outside of your thigh. If it is too tight, it can cause excessive friction near the knee.

Patellar Tendonitis – This is an overuse injury that causes the patellar tendon, the tendon connected to the shinbone and the knee, to weaken and eventually tear if it goes untreated. 

Patellofemoral Malalignment – This occurs when there is excessive lateral pressure on the patellofemoral articulation. It is characterised by pain in the anterior part of the knee.  In addition to this, other common diagnoses for knee pain caused by muscle imbalances in runners are patellar tendonitis and patella-femoral malalignment.

How does this occur?

As your knee bends and straightens, your thigh muscles (quadricep muscles) pull your kneecap into a groove on your femur. The articular cartilage, which covers the surface of the patella, rubs against the groove of the femur. This causes irritation which leads to the bone beneath it becoming painful. 

The more compression from movement with resistance, the greater the pressure that develops at this joint. This increase in pressure causes an increase in friction at the patellofemoral joint. 

How to assess if you have an imbalance and might need preventative treatment.

A way to assess an imbalance that might cause patellofemoral pain is to look at where your knees are in relation to your feet when sitting down. 

If they are closer together than your feet, your hips may be in a position called hip internal rotation, indicative of an imbalance. A major role of the glutes is to externally rotate our hips, imbalances in the function and strength of the glutes cause the hips to internally rotate causing problems down the chain. 

Another way to assess your hip and knee alignment is to stand in front of a mirror wearing shorts or roll your pants up so you can see your knees. Notice which way your knee caps are facing, straight ahead or slightly toward the middle. 

Contract your glutes and hold for a second or two, then relax and closely watch your knees. If you do this process a few times, you should see your knees slightly rotating out as you tighten the muscles. If your knees are in proper alignment with your hips, your kneecaps should be facing directly forward, which happens when you tighten your glutes. 

This self-assessment exercise allows you to see the correlation of hips, knees, and feet together; improper alignment at one end of the chain can negatively affect something at the other end, this is why patellofemoral pain can be caused by things outside of just the knee.

What does the treatment consist of?

Rehabilitation exercises are the most common form of treatment, it allows the underlying problems causing the pain to be addressed such as muscle imbalance due to overuse. Specific exercises can strengthen the muscles that support your knees and control limb alignment, such as your quadriceps, hamstrings and the muscles around your hips, especially hip abductors. Correcting inward movement of the knee during squatting is a primary goal so that valgus knee can be fixed.  The antagonistic muscles of the ones that are overused are strengthened to balance out irregularities.

Supportive braces can allow you to keep exercising while you get help with the condition. Knee braces or arch supports may help improve pain by moving the position of the patella so it doesn’t degrade the ligaments in your knee and cause lasting damage and pain.

Taping acts in the same way that supportive bracing does, repositioning the patella to stop the ligaments from degrading and causing pain.  Your physical therapist may show you how to tape your knee to reduce pain and enhance your ability to exercise.  Taping allows for more range of movement than a supportive brace and is cheaper than buying the apparatus.

Why Use Physiotherapy for Treatment? 

Your City Physiotherapy & Sports Injury Clinic Adelaide physio can diagnose and treat this painful condition. The best practice is to get early intervention so your kneecap irritation doesn’t cause a breakdown in cartilage. Our physiotherapists will assess your knee injury and surrounding muscles by analyzing your lower limb biomechanics.  

Physiotherapy for your patellofemoral pain will assist in returning you to your activities that you enjoyed before it was interrupted by the condition.  Your physiotherapist will also instruct you on ways that are necessary to keep the syndrome at bay and allay chances that it returns.

Your physio will provide you with hands-on care, which may include taping or release of stiff joints and muscles. Often, your physio will also recommend some longer-term exercise rehabilitation solutions to your patellofemoral pain syndrome.

Book online today with City Physio in Adelaide for an assessment on your knee from one of our qualified physios and start your journey to recovery with our qualified and highly experienced physiotherapists.

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