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What is Patellofemoral Pain?

One of the most common causes of knee pain in young, healthy athletes is patellofemoral pain. Patellofemoral pain syndrome is often referred to by many different names, some of which include: anterior knee pain, patellofemoral malalignment, chondromalacia patellae, patellar hypermobility, or patellar tilt. It is important to note that although there are many different names that can describe patellofemoral pain, they are all referring to the same pathology.

The knee joint is made up of three bones; the patella (kneecap), the femur (thigh bone) and the tibia (shin bone). The patellofemoral joint refers to the joint between the kneecap (patella) and the femur. During normal knee mechanics and movement, the patella glides smoothly in the center of the trochlea or femoral groove (a groove located on the lower end of the femur). When normal knee mechanics are interrupted either due to acute injury or overuse, pain and dysfunction occur.

Patellofemoral pain is a catchall phrase used to describe pain in the front of the knee, normally during sports that involve running and jumping. Patellofemoral pain is normally seen in young active adolescent females, but this syndrome can also affect young males as well. Patellofemoral pain is commonly an overuse injury but can also occur due to improper movement of the patella during activity and can sometimes be caused by an acute injury, such as a fall or hit to the knee. While the problem is common its diagnosis is sometimes difficult to make and understand. Once the diagnosis is made however, it is usually treatable with a high likelihood of return to full sports and recreational activity.

Causes

  • Overuse of knee, with improper strength and mechanics
    – Weak hip and thigh musculature
  • Patellar malalignment: (uneven femoral groove; shallow femoral groove) causing patella to move incorrectly
    – With patellar malalignement the patella is normally pushed to the outside (lateral) of the groove when the knee is bent. This abnormality can cause pressure between the underside of the patella and the femoral groove
    – If patella is not correctly aligned, cartilage under the kneecap may become damaged and painful; this is called chondromalacia
    – Valgus knees (knock knees) can predispose an athlete to patellofemoral pain
  • Direct blow or fall on the kneecap causing soft tissue injury

Signs & Symptoms

  • Pain in the front of the knee, increased with physical activity and walking up and down stairs
  • Pain on the inside or around the kneecap
  • Feelings of catching or popping during activity
  • Pain when sitting
  • Feelings of creaking or cracking sounds during movements (i.e., bending and extending the knee)

Treatment

Initial treatment of patellofemoral pain is to decrease or remove aggravating activities, such as running and jumping.  Rest, along with ice and anti-inflammatories can also help to decrease inflammation and pain. Patellofemoral pain should be treated with a bout of physical therapy to stretch and strengthen the lower extremity musculature.

Physical therapy, as well as home exercises that focus on strengthening the thigh, hip and core musculature, is important to provide dynamic stability and ensure proper tracking of the kneecap during movement. Focus on strengthening the quadriceps/ thigh musculature is pertinent as these muscles control the movement of the kneecap. Stretching of the lateral structures of the lower leg, such as the iliotibial band (IT band) as well as the hamstrings is also important. Use of a knee brace to help support the patella during activities of daily living and physical therapy exercises can be helpful in reducing pain.

Once normal knee range of motion and strength is regained, and proper patellar tracking is attained, a slow progression back into sports as tolerated is suggested. Continuation of home exercises focusing on the strengthening of thigh and hip musculature is important for maintenance of patellofemoral alignment and proper mechanics.

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