Patellofemoral pain syndrome is the medical term to describe pain in front of the knee and around knee cap. Patella is the knee cap. This condition is sometimes called runner’s knee or jumper’s knee as it is prevalent in athletes and sports players.
Aetiology
- Overuse
- Structural malalignment
- Imbalance of vastus medialis and vastus lateralis*1,2
- Young athletes and sports players
- Weak hip abductors in female *4,5
- Foot eversion with tibial internal rotation *6
- Hamstrings tightness *7
Study *2 shows people with PFPS activate vastus lateralis first before vastus medialis gets fired on while people with no issue do not have this activation imbalance of these muscles when step up and down.
Sign and symptoms
- Anterior knee pain during exercise and activity such as running, climbing stairs, squatting and jumping
- Pain with prolonged sitting or sustained knee bent
- Cracking sound when you move your knee
- Pain anteriorly when squatting
- Pain during kneeling
Differential Diagnosis
- ITB syndrome
- Biceps Femoris tendinopathy
- Osgood Schlatter syndrome
- plica syndrome
- osteoarthritis
Special tests for patellofemoral syndrome
- Clarkes sign (Patella grind) https://www.youtube.com/watch?v=pRqnODPqxFs
- Patella Tracking while squatting if the patella shifts or rotates laterally *1
- Resisted Knee extension
Treatment
- Ice and tape when it is acute stage
- Restore the ROM with stretch and mobilisation
- Strength training on quads, *8hamstrings and muscle to make foot arch*8,9
- Massage therapy to release the tight muscle and keep ROM
- Decrease the intensity of the exercise
Quads Exercises
- Isometric squat
- Front lunge (Step forward and bring the front leg back)
- Resisted band squat
Exercises are often utilized in physiotherapy treatment. Closed kinetic chain(Feet or arms are fixed position such as squat and push ups) and open Kinetic chain exercise such as leg extension and leg curl can both improve pain with PFPS. *8
Knee is one of the most complex joints. Even if patients complain about pain in front of the knee, it can be any other pathology Therefore, make sure to suspect other pathology and rule out others such as tendinitis, Osgood Schlatter syndrome, bursitis, traumatic injuries, osteoarthritis, plica syndrome, Sinding-Larssen-Johansson syndrome and patellar luxations.
References
- Wolf Peterson, Andree Ellermann, Andreas Gosele-Koppenburg, Raymond Best, Ongo Volker Rembitzki, Gerd-peter Bruggemann and Christian liebau Patellofemoral pain syndrome Knee. Surg Sports Traumatol Arthrosc 2014 22 (10):2264:2274
- Cowan SM, Bennell KL, Hodges PW, Crossley KM, McConnell J. Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Arch Phys Med Rehabil. 2001;82(2):183–189
- Pal S, Draper CE, Fredericson M, Gold GE, Delp SL, Beaupre GS, Besier TF. Patellar maltracking correlates with vastus medialis activation delay in patellofemoral pain patients. Am J Sports Med. 2011;39(3):590–598
- Baldon R, Nakagawa TH, Muniz TB, Amorim CF, Maciel CD, Serrão FV. Eccentric hip muscle function in females with and without patellofemoral pain syndrome. J Athl Train. 2009;44(5):490–496
- Bolgla LA, Malone TR, Umberger BR, Uhl TL. Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2008;38(1):12–16
- Barton CJ, Levinger P, Crossley KM, Webster KE, Menz HB. The relationship between rearfoot, tibial and hip kinematics in individuals with patellofemoral pain syndrome. Clin Biomech (Bristol, Avon) 2012;27(7):702–705
- White LC, Dolphin P, Dixon J. Hamstring length in patellofemoral pain syndrome. Physiotherapy. 2009;95(1):24–28
- Heintjes E, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Exercise therapy for patellofemoral pain syndrome. Cochrane Database Syst Rev. 2003;4:CD00347
- Harvie D, O’Leary T, Kumar S. A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works? J Multidiscip Healthc. 2011;4:383–392
