What is Patellofemoral Pain/Patellofemoral Syndrome?
The knee has two major joints: (1) the tibiofemoral joint, and (2) the patellofemoral joint, which is the one affected in PFP/PFS. A normal, healthy knee has bones, cartilage, tendons, and ligaments. The patella (kneecap) travels within the trochlear groove of the femur and glides through this with flexion and extension of the knee joint. This is known as “patellar tracking”. If the patella is not tracking properly within the trochlear groove, pain can occur. This plays a key role in the development of PFP/PFS.
Patellofemoral pain syndrome is an umbrella term encompassing the pain from the patellofemoral joint and/or the surrounding tissues. This condition is chronic, and pain typically worsens with squatting, sitting, descending and ascending stairs, and running. Patellofemoral pain is typically felt in the front of the knee (anterior knee pain) but can be felt surrounding the entire knee joint. This condition is most prevalent in young adults, particularly females, and is more common in athletes.
How did I get Patellofemoral Pain/Patellofemoral Syndrome?
As mentioned above, one of the main causes of PFP/PFS is patellar misalignment, where the patella will not properly track within the trochlear groove of the femur. There are many causes of patellar misalignments, such as a muscular imbalance in the quadriceps (specifically a delayed activation of the Vastus Medialis muscle), deviation of the patella, or other biomechanical factors.
This can also occur from vigorous activity that puts stress on the knee joint, specifically if there is a sudden onset or increased frequency of activity. If there is a pre-existing misalignment in the patella, increasing activity levels and stress on the knee will only exacerbate the issue and cause injury to the surrounding tissues, resulting in pain.
Foot alignment can also play a role in PFP/PFS. Pes planus, or pronation of the foot, and Pes cavus, or supination of the foot, can both cause PFP/PFS by putting high stress on the patellofemoral joint.
Symptoms of Patellofemoral Pain/Patellofemoral Syndrome
Symptoms of this condition include, but are not limited to:
- anterior knee pain (pain at or surrounding the patella)
- pain worsened by prolonged sitting with knees bent
- pain with kneeling, squatting or using stairs
- popping or crackling sounds in the knee during movement
- pain with activity that puts stress on the patellofemoral joint (ex. running, jumping, etc.)
How is Patellofemoral Pain/Patellofemoral Syndrome Diagnosed?
Firstly, your physiotherapist will ask you to describe the behaviour of your pain such as when it began, what it feels like, and if/when it gets worse and with what activities. This way, your physiotherapist can rule out certain diagnoses and hopefully get a clearer idea of your condition. It is likely that a physical examination will be performed to determine the location of the pain, and your physiotherapist may perform special tests to help rule out/in certain diagnoses. Your stability, muscle strength, flexibility, and anatomical alignment of your lower body may also be assessed to determine the best course of action for treatment.
Treatment of Patellofemoral Pain/Patellofemoral Syndrome
Common treatments for PFP/PFS include the RICE protocol, lower extremity strengthening and stretches, taping, bracing, and more. This condition can commonly be treated with physical therapy and exercise to rebalance the quadriceps muscles and stabilize the patella.
