Patellofemoral pain syndrome (PFPS) is a fairly common condition that causes knee pain in both the athletic and nonathletic population. If left untreated PFPS can elicit symptoms which may prevent a person from jogging or performing a high intensity sport, in some cases even climbing the stairs may become a painful task. On average runners and younger athletes are at greater risk for developing PFPS. Also women are more likely to develop PFPS than men. People who develop PFPS usually report pain around or just behind their knee cap. Pain is usually experienced while squatting, running, kneeling, ascending/descending stairs, and during prolonged sitting.
There are two main methods by which PFPS may develop. Normally, whenever we bend our knee our knee cap (i.e. the patella) shifts downward and when we straighten our knee the patella shifts upwards almost as it was moving smoothly along a “track”. The first method by which PFPS can develop involves the quadriceps muscles. The quadriceps muscle is actually made up of 4 different muscles and when one of these muscles becomes stronger than the others this can lead to a muscle imbalance. Usually the muscle called the vastus lateralis which is located on the lateral portion of the thigh becomes much stronger than the muscle called the vastus medialis which is located on the inner thigh. As a result the knee cap (i.e. the patella) is pulled outward and whenever the person bends and straightens their knee the patella is shifted slightly off the “track”. This constant pulling of the knee cap can wear out the cartilage underneath the knee cap. When the cartilage is worn down inflammation and often pain usually follows. Another mechanism by which PFPS can develop involves the hip musculature. In some cases the entire thigh bone can be slightly rotated outwards which causes the knee cap to appear shifted slightly laterally. This excessive rotation can be caused by weak hip musculature, muscle imbalances of the hip or the muscles surrounding the hip can become tight. Because of this misalignment, cartilage is worn down when a person bends and straightens their leg.
In very mild cases a person may be able to use RICE (rest, ice, compression and elevation) to treat PFPS, but in more moderate to severe cases physical therapy is often required. After a thorough history and physical examination a physical therapist will determine by which method the PFPS has developed and what exercise treatment to employ. If significant muscle imbalances of the quadriceps are evident then exercises that strengthen the quadriceps specifically the vastus medialis will be implemented in order to minimize these muscles imbalances and prevent the patella from being pulled outward. If a patient presents with muscles imbalances of their hip or demonstrate excessive hip rotation then the physical therapist will focus on strengthening and stretching the hip, which will reduce these abnormalities. A physical therapist will also perform taping techniques to reduce the excessive pull on the patella and to place it more towards the center of the knee. This will help keep the patella on the “track” when the person bends and straightens their knee. Also when people are diagnosed with PFPS they often present with painful trigger points in the muscles located around the knee. A physical therapist will use hands on techniques to release these trigger points.
Furthermore, a physical therapist will also instruct the patient on how to utilize a foam roller to aid in releasing these trigger points on their own. As the patient begins to improve a physical therapist will then work with the patient to develop a running program that will allow them to gradually return to high level activities such as running or their favorite sport.
If you’re experiencing any of the previously mentioned symptoms don’t delay, contact Total Performance Physical Therapy today.