If you suffer from pain on the front of the knee, or behind the kneecap (patella), there is a good chance it is patellofemoral pain (PFP). This injury is very common and affects many different people; although, it is most prevalent in adolescents and those who are physically active. Patellofemoral pain is often felt during and made worse by, physical activities such as squatting, running, jumping, and going up/down stairs. Other common symptoms include: grinding sensations when bending the knee, tenderness over the patella, mild swelling, and pain at the front of the knee while sitting, straightening the knee after prolonged sitting, or getting out of a chair. This injury often limits a person’s ability to participate in their chosen sport, activity, and/or work duties.
The recovery time for PFP pain varies from person to person. Typically, PFP does not disappear on its own; therefore, in order to have the best chance of recovery and reduce the likelihood of it recurring, a progressive strength and mobility program is the gold standard treatment.
Essential Anatomy
To better understand PFP, it is important to understand some basic human anatomy. The knee consists of two major joints, the tibiofemoral joint, and the patellofemoral joint; the latter of which will be discussed.
The patellofemoral joint is made up of the patella and the femur (thigh bone). The patella is a triangular-shaped bone, with its underside covered in articular cartilage. This cartilage provides a cushioning effect and reduces the friction when the patella glides against other surfaces. The patella sits within the trochlear groove on the femur (thigh bone). This groove helps maintain the alignment of the patella and stops it from moving laterally. The patella is also held in place superiorly by the quadriceps tendon and the patella tendon distally. These tendons play a major role in stabilising the patella and preventing dislocation.
The primary extensor of the knee joint is the quadriceps muscle group. It is made up of four muscles; rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis. The vastus medialis stabilises the patella against being pulled laterally, whilst the vastus lateralis muscle and iliotibial band work in synergy to help support normal movements of the knee cap. Imbalance in this musculature may affect the articulation of the patella within the trochlear groove of the femur during motion and can irritate the tissues surrounding the kneecap.
What causes patellofemoral pain?
Patellofemoral pain occurs due to a variety of reasons. In some cases, the trigger is difficult to pin down as there may be no specific incident that caused the injury, rather that it gradually increased over time. In others, pain may arise after a sudden change in knee loads (i.e. a sudden increase in physical activity, running more on hills, growth spurt, increased weight training, etc.). The most common contributors to PFP are:
- Weakness in the quadriceps muscles
- Weakness in the hip/buttock (gluteal) muscles
- Tight musculature of the quadriceps (thigh)
- Variations in anatomy including - a patella that sits higher or wider in its groove, a shallow femoral groove, variations of the shape of the femur that cause the knee to turn inwards and, different foot postures such as pronation (flat feet)
Taking into account the aforementioned, it is also important to rule out other causes of knee pain with similar symptoms, such as patellofemoral osteoarthritis and patellar instability.
As you can see, PFP can have a variety of causes any number which may be contributing to your knee cap pain! Your physiotherapist can help to assess the most important factors which once addressed, will often lead to the quickest recovery.
Physiotherapy treatment
In all cases of PFP, causative factors must be identified and addressed to ensure long-term recovery. This may include, but not limited to, problems with flexibility, control, and strength of the hip, thigh, and knee regions. Your physiotherapist will advise you on how to manage aggravating activities and instruct you on safe exercises and movements you can complete during your rehabilitation. In addition, the use of patella taping or bracing, foot orthotics, and manual therapy may be applicable in certain cases.
Mobility:
Common flexibility issues include:
- Tight musculature of the outside of the thigh
- Tight musculature of the hip/buttock region
- Tight calf muscles
- Stiff ankle, hip, or knee joints
To address these, physiotherapists use manual therapy and soft tissue massage, as well as teaching our clients to stretch and perform self-treatment with tools, such as foam rollers.
Control:
Control refers to the ability for an individual to monitor and adjust their body position and posture through a variety of different settings. When it comes to PFP, control of the hip and knee joints is very important. Your physiotherapist will assess your control to determine if this a contributing factor to the problem.
In many cases, control exercises have a beneficial therapeutic effect as they introduce the body to a safe and pain-free ranges of motion that the person may not have been aware of.
Strength:
Strength is very important when it comes to the rehabilitation of PFP. Strong and resilient tissues promote optimal function and are less likely to become tight or weak. Therefore, it less likely these structures will become sensitized when under pressure from increased loading.
Summary
In summary, if you are suffering from PFP remember:
- Patellofemoral pain is very common and commonly treated by Physiotherapists
- Changing your activities and reducing your aggravating loads are effective ways at reducing knee pain
- Flexibility, control and strength deficits need to be identified and addressed
- A targeted strength and mobility program addressing individual contributing factors is the gold standard in treating and preventing PFP pain!
If you are experiencing knee pain, book in with your physiotherapist for a thorough assessment using this link – FREE INITIAL ASSESSMENT. Once the cause has been identified the road to recovery can begin.
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