Patellofemoral Pain Syndrome (PFP), pain at or near the knee cap, is traditionally known as movie-goers knee or patella tracking disorder. It actually accounts for almost 50% of all running injuries and is usually a poorly localised pain found around, near or under the knee cap. It has a greater predilection in females and is often aggravated by running hills, descending stairs, lunging, squatting or sitting for prolonged periods.
Patellofemoral Pain Syndrome Causes
The cause of PFP is often multi-factorial and therefore requires thorough assessment including lower extremity movement patterns (including foot mechanics) and any strength deficits often determined by specific muscle testing. What is important and often missed is not just an assessment to the knee itself, but the potential functional mechanic distortion patterns for example in the pelvis, feet or hips as well as the muscle weakness this can cause. These are often cited as the predominant cause of pain. It is important to state simply that the knee is the middle joint and therefore subjected to greater force from any alterations in function above or below the knee.
A common finding in running associated with PFP is a pelvic drop on the opposite side and on the same side, increased hip adduction (weak hip abduction), weak quadriceps and weak intrinsic foot strength. To improve movement patterns, a common approach is to strengthen these particular muscles that control and regulate such movements. Unfortunately there is inadequate evidence to support hip muscle strengthening on the pelvic drop side. It appears from various studies that improvements in strength are also not associated with changing kinematics. A multiple approach is required.
During a running gait, the plantar flexor (toe pointing) muscles play an important role as force absorbers and the peak ground reaction force is often two to three times the bodyweight (one to two during walking). More force is taken through these muscles than the hip itself. A muscle called the soleus is the prime loader here. This area (the back of the calf) is another area requiring attention for patellofemoral pain syndrome.
Patellofemoral Pain Treatment
Treatment should therefore encompass strengthening, exercise, manual therapy, Low level laser and taping assessing the entire lower limb and pelvis/hip complex. Photobiomodulation (laser) can help reduce pain, inflammation and swelling as well as promote repair. Foot orthoses could be prescribed if required in individuals with exacerbated pronation. Patellofemoral pain syndrome exercise therapy has been found to be very important in recovery as strengthening alone is generally not enough for long term relief for PFP.
Various studies in running gait retraining have shown that loading patterns can be altered for improvement and could therefore be the key to long term recovery. Foot strike, stride length and hip adduction angles are reviewed. Increasing the step rate in small increments has shown to reduce hip adduction and reduce patellofemoral joint stress by 10-22%. It is important to note that not all requires running retraining and to be cautious in making excessive changes too soon.
Ensuring optimal recovery and monitoring training load also make a large difference in recovery. it is also important to note, that if the biomechanics of the lower limb are at fault and not corrected, then there is a possibility that knee osteoarthritis can develop.
Often following injury, muscle memory can create a problem in recovery. A neuro musculo-skeletal approach can therefore be highly beneficial here.
Do you suspect Patellofemoral Pain Syndrome? Need a chiropractor for knee pain? Please call our clinic on 9418 3930 for a consultation and free foot scan.