Patellofemoral pain syndrome is pain that occurs in the knee mainly when the patella or kneecap is not positioning correctly in the joint when your knee bends or straightens.
In the knee joint, the patella is supposed to be positioned in the groove of the femur. If it runs outside of that groove, then the patella rubs on the femur below it. This bone-on-bone rubbing is what causes the pain.
In my practice, I have seen it happen mostly in adolescent females, although I have seen it in males.
Females are more likely to have PFPS for a couple of reasons:
- Wider pelvis in females increases the angle of the knee joint
- Women tend to be weaker all around
- Females also have increased laxity or flexibility of the ligaments in the hips and knee
Who does PFPS occur in?:
This mainly occurs in athletes that run or jump during their sport for example: basketball, volleyball, track, and gymnastics. But pain can also occur during walking, going up and down stairs, or even sitting for a long period of time.
PFPS can also be exacerbated by growth spurts. I have treated patients with this issue that did not play sports, these kids usually are going through a growth spurt and the muscles have become too weak.
There are a couple of reasons PFPS happens
- It is an overuse injury, meaning doing too much of the sport activity
- Weakness of the muscles of the knee AND the hip. Muscles like the quadriceps, gluteus maximus and Medius, and Tensor Fascia Latae (TFL).
- The weakness of hip muscles leads to the knee buckling inward and the kneecap going in the opposite direction.
Rest from the specific sport can help with pain, however, this will not fix the underlying issue and most of the time young athletes do not want to miss the sport.
Physical Therapy can help and reduce the amount of time out of the specific sport. A combination of exercises and manual therapy can treat the cause of the pain and have them back within a couple of months, if not sooner.
Knee exercises:
Long Arc Quad with ball squeeze
Lateral Step downs
Straight Leg Raise
Wall sit
Hip exercises:
Clamshells
Hip abduction
Hip Adduction
Bridges
Donkey kicks
Perform 3 set of 10 repetitions of each exercise except for the wall sits which should be held for 30 seconds 3 times. The exercises I have listed are ones that can easily be performed at home to strengthen the hip and knee. You can even make them harder by adding a weight or resistance band.
However, there are more exercises in clinic that utilize more equipment that will also be beneficial. There are also manual therapy techniques that I would perform on the patient to help further their rehabilitation. Check out this post to see what manual therapy is.
Completing these exercises will target the specific muscles to help the patella track better in the femoral groove and reduce the amount of pain.