Patello-femoral (knee cap) pain syndrome

Patello-femoral pain syndrome (PFPS) means pain relating to the patella (knee cap) and the femur (thigh bone). The knee cap sits in a small grove in the femur and slides up and down in this grove. If for some reason the patella is not correctly aligned in the grove then pain can result. This is known as patello-femoral mal-tracking.

The pain is located behind and/or around the knee cap and is most often felt with running or walking down hills and stairs and with squatting. Kneeling and putting pressure on the knee can also be very painful and often prolonged sitting can result in pain. Women are affected more than men, and there is a very high incidence in adolescent girls. There may be some swelling associated with the injury. It may occur from a sudden injury but most often is an overuse injury resulting from repeated poor positioning on use. Recent research has indicated that ongoing pain in the region can result in early onset osteoarthritis (degeneration). Therefore it is extremely important to get this injury treated.

If the injury is to be rehabilitated then a correct assessment of why the mal-alignment is occurring must be made. There are many reasons.

  • Poor hip control – if the hip is weak then the knee tends to drop inwards when you single leg squat. This puts the femur in the wrong position. Good gluteal (buttock) muscle strength is essential to correct the femoral alignment, keeping the knee straight as you squat.
  • muscle imbalance – the VMO is one of the quadriceps (front of the thigh) muscles. However it is more concerned with control of the knee rather than straightening the knee. It helps to hold the knee cap in the grove. Pain inhibits this muscle, that is, it stops working effectively. This affects the knee cap control allowing it to drift to the outside of the knee. Getting this muscle working is essential in stopping PFPS. Your physio can teach you how to do this. There are many ways you can learn to tape the knee cap that will help to position the knee cap better whilst the muscles strengthen. This means that with tape you can often keep exercising. Your physio will teach you how to best tape your knee cap.
  • muscle tension – over tight muscles pull the knee cap out of position. The vastus lateralis is a huge muscle on the outside of the thigh and is often responsible for overworking and pulling the knee cap outwards. Massage and dry needling are great ways to get this loosened off. All the quads run over the knee cap so stretching this muscle group by pulling your heel up behind you can help. The muscles at the back of the leg (calf and hamstrings) can also be to blame so stretching these can also be of benefit
  • compensation – this is when you have an injury or weakness somewhere else which means you now need to put more pressure on the knee. Common examples are a stiff ankle after an ankle sprain or an injury to the opposite knee or hip forcing you to put most of your weight in the other side. Your physio will help assess these compensatory patterns which may very well also need to be addressed.

PFPS is a very complicated injury but with careful assessment and treatment excellent results can be achieved. To find out more please contact the team at Physiologix, upstairs at the gym. Alternatively give us a call on (07) 3511 1112 or contact us via email.