Matt Cornwall, Physiotherapist at our Guthrie House branch, discusses patellofemoral pain, a very common knee complaint that can affect people of all ages and can interfere with functional day to day activities and sport.
What’s the role of the patella (knee cap)?
The patella essentially functions as an anatomic pulley for the quadriceps muscle. It increases the lever arm of the extensor mechanism in the knee, thus allowing for more effective knee flexion and thus increases the strength of the quadriceps by 33-50%.
The patella is however a free floating bone and as such is subject to movement by the forces that connect with it. This can potentially result in altered movement, compression and ultimately pain.
What is Patellofemoral Pain Syndrome?
Patellofemoral Pain Syndrome (PFPS) is a term used to describe pain in the front of the knee and around the patella. This injury although not serious can cause disability and reduced function.
It is caused by compressive forces in the patella-femoral joint with symptoms of pain being provoked by climbing or descending stairs, squatting or sitting with flexed knees for a long time.
What other conditions could be causing anterior knee pain?
There are a number of other structures at the front of the knee that can cause pain including but not limited to:
- Patella tendinopathy
- Patella bursitis
- Knee osteo-arthritis
- Meniscal issues
It is important to make sure that you get an accurate diagnosis to ensure the best treatment thereby ensuring a quicker resolution of the issue. A physiotherapist will be able to help in determining the source of the pain.
Potential risk factors for PFPS
- Overuse, overloading and misuse of the knee.Factors include:
- A sudden increase in running mileage or training
- A change in sports shoe
- A sudden change from sedentary to active
- A change in playing surface
- Reduced muscle strength in the hip and knee musculature
- Minor problems in the alignment of the knee
- Foot problems related to flat feet
- A culmination of minor injures to the knee due to sport or hypermobility
Most commonly PFPS is associated with pain it is usually described as a generalised aching sensation but during flare ups it can cause sharp pain, the onset is usually gradual and there is usually no discernible trauma that patients can pin point to the start of their pain.
Other less frequent symptoms can be a clicking or grating sound, commonly known as crepitus. Mild swelling can also occur, this can usually be seen if the knee has been particularly overloaded or overworked.
How to go about managing PFPS
If left untreated PFPS can cause persistent annoying pain, however with the right interventions PFP can be managed and allow you to return to pain free activity.
- Rest from aggravating factors – In the short term this is important to help let the knee settle and allow for healing.
- Taping – Also in the short term can be an effective way to help reduce pain.
- Brace – Depending on the severity of the pain and your functional status a more vigorous form of protection may be needed in the early stages. A physiotherapist will be able to guide you on what is best.
- Massage – Tightness of certain muscle groups can contribute to PFP and a range of massage techniques can be employed to help to reduce your pain.
- Stretching/foam rolling – Certain muscle groups can have an effect on the knee especially around the hip. Stretching of these muscles can help to release tension that may be helping cause compression at the knee.
- Strengthening – This will be one of the key factors in helping you settle your pain and allowing you to return to your chosen activity.
- Correction of predisposing factors – In conjunction with previous two points ensures that the problem doesn’t re-occur and can include advice on training principles (overload and recovery) and biomechanical issues such as lower limb mechanics including foot posture and function.
If you are experiencing pain or discomfort in the front of the knee or around the patella then come and see one of our trained physiotherapists who will thoroughly assess the knee and determine the route cause of the problem. From this they will be able to give the best treatment and advice and guide you through the rehabilitation process back to full fitness.
Bolgla, L. Hip Strength and Hip and Knee Kinematics During Stair Descent in Females With and Without Patellofemoral Pain Syndrome. Journal of Orthopaedic & Sports Physical Therapy, 2008 Vol 38 Issue 1 pp.12–18.
Chaconas, E. Mobilization with movement symptom modification procedure for a 38 year old male with patella femoral pain syndrome. Manual Therapy, 2016, Vol 25 pp.63-65.
Crossley, K. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). British Journal Sports Medicine, 2016, Vol 0 pp.1–9
Crossley, K. A Systematic Review of Physical Interventions for Patellofemoral Pain Syndrome. Clinical Journal of Sport Medicine, 2001 – Vol 11 Issue 2 – pp.103-110.
Fagan, V. Patellofemoral pain syndrome: a review on the associated neuromuscular deficits and current treatment options. British Journal Sports Medicine, 2008 Vol 42 pp.789–795
ABOUT THE AUTHOR
Matt is a UK trained physiotherapist working at the Guthrie House branch of City Osteopathy and Physiotherapy. Matt has a strong interest in sports rehabilitation, ensuring the best evidenced practice to help you reach your peak after an injury. Matt is a keen athlete playing rugby and participating in many running and triathlon events across Asia.