Patellofemoral Knee Pain Syndrome

Knee Pain Introduction

Knee pain is extremely common amongst modern human beings. We don’t know for sure how much knee pain our ancestors suffered with but there is a certain amount of evidence to suggest that they had their knee pain issues too.

Your knee joint sustains a biblical dose of punishment during the course of your lifetime. In fact the human knee takes such a beating from our evolutionary design that it can be seen in the ‘fossil record’ to have grown exponentially as soon as we started standing upright.

Knee pain is common, and the most common form of knee pain is patellofemoral pain syndrome. Put simply patellofemoral pain syndrome is a knee pain condition caused by ‘tracking’ issues in the groove between the kneecap (patella) and the front of your thigh bone (femur). Smooth tracking of the patella under healthy circumstances is managed by the strength, flexibility and alignment of the muscle and soft tissues of the entire leg and foot.

Patellofemoral Knee Pain – The Symptoms

Patellofemoral knee pain syndrome is caused by the patella (kneecap) rubbing repetetively on the femur bone. The rubbing of these 2 bones causes irritation to the cartilage and neighbouring soft tissues, over time this can lead to inflammation, microscopic scar tissue formation, and of course pain.

Symptoms of patellofemoral knee pain syndrome can include various types of pain. The primary hallmark of patellofemoral knee pain is its location at the front of the knee. The pain itself can show up as an aching pain or a sudden sharp pain at the front of the knee at different times.

There may be tenderness along the margins of the knee cap and swelling will sometimes occur after exercise. Patellofemoral pain is often aggravated by hill walking and sitting for long periods. Many cases of patellofemoral pain syndrome also present with clicking sounds during knee movement, especially coming out of deep knee flexion.

Patellofemoral  Knee Pain Syndrome – Who Gets It

In the same way that more serious conditions like heart disease can take a long time to manifest, tracking issues with the patella can continue for years before pain develops. In other words, people who develop patellofemoral knee pain syndrome are people who have had movement issues with their knees for an extended period of  time.

In one sense patellofemoral pain syndrome develops in those who are prone to overuse. Most people who develop patellofemoral knee pain have undergone a recent increase or change in activity. It is important to understand that this period of activity is not in itself the full ‘cause of the pain, rather it is a trigger that brings an underlying problem to light.

Patellofemoral pain is very common in active people and those who play a lot of sport, it can effect anyone from adolescent girls to middle aged men. Like all lower body pain syndromes patellofemoral pain is also more likely to occur in people who spend a significant amount of time being active on hard surfaces like concrete and tarmac. Patellofemoral pain syndrome is also more likely to occur if you have flat feet or high arches. As is so often the case with pain conditions, those who develop patellofemoral pain syndrome usually have multiple factors perpetuating their pain.

Patellofemoral Knee Pain – External Risk Factors

There are numerous external risk factors that can increase your risk of developing patellofemoral knee pain. Most inevitably relate to environment, others are based in lifestyle and what we wear on our feet.

Our ancestors evolved to walk and run on soft, contoured, yielding surfaces and they often didn’t make their 40th birthdays, we spend a lifetime on extremely hard flat ground.  

Intense and/or extended activity on hard surfaces is most likely by far the biggest external risk factor for patellofemoral knee pain syndrome. Think of running marathons on tarmac and playing squash on hard squash courts as being 2 of the best examples.

Wearing inappropriate footwear is a common factor in cases of patellofemoral pain syndrome. Modern, fashionable footwear is generally far too narrow for the bones of our feet, over time this can destabilise the foot, ankle and knee. Wearing sports footwear that isn’t fit for your specific purposes can also create problems. It is often a good idea take advice on footwear from people who work in the healthcare field rather than those who work in retail.

A major factor in many cases of patellofemoral knee pain syndrome is the unfulfilled need for custom orthotics or insoles in people who have flat feet and high arches. People with flat feet and high arches are particularly sensitive to irritation from hard urban surfaces, in many cases this creates a need for orthotic prescription.

Patellofemoral Pain Syndrome – Internal Risk Factors

Muscle weakness is a key factor in every case of patellofemoral pain syndrome I have seen in 20 years in the ‘front line’ of pain management. Muscle wasting in the gluteal muscles and the quadriceps are standard issue. These muscles play a primary and integral role in stabilising the patella what we walk, bear weight and run.

Tightness down the outside of the thigh, in the iliotibial band and tensor fascia muscle is a key ingredient in most cases of patellofemoral knee pain syndrome. The fascia and soft tissues at the outside of the thigh regulate tracking of the patella, if these tissues are too tight they pull the patella laterally during movement. 

Having flat feet & high arches both make it far more likely that you will develop patellofemoral knee pain syndrome and just about every other lower body pain on record. Your feet are the mechanical foundation of your whole leg and that includes your knees. Unusual foot anatomy does not mix well with unnatural surfaces like concrete, paving and tarmac, this is a recipe for pain.

Poor running technique and unusual postural habits in the lower half of the body can both lead to mechanical issues with the knee and patellofemoral knee pain syndrome. Identifying poor postural and movement habits in the lower body is important for many with stubborn knee pains.

Unrehabilitated injuries are a major and often overlooked factor in many stubborn knee pain cases. As a culture we are not the best at following through on full rehabilitation of injuries. Residual scar tissue and muscle weakness anywhere in the leg can predispose us you stubborn complaints like patellofemoral knee pain syndrome.

A relatively small percentage of people who suffer with patellofemoral knee pain syndrome have birth defects that are significant underlying factor. The simple fact is that a percentage of humans are born with hip and foot defects at birth, these can predispose you to complaints like patellofemoral knee pain syndrome. The good news is that even with the presence of birth defects most cases can be rehabilitated through the right treatments and exercises..

Patellofemoral Pain Syndrome – Pain Treatment

Treatments that reduce pain signals and increase blood flow to the soft tissues of the knee can be a great relief for sufferers of patellofemoral knee pain syndrome. These treatments can include acupuncture, deep tissue release, cupping, myofasciasl trigger point therapy and graston technique. Treatments of this nature usually need to be perfomed repeatedly to trigger a consitent reduction in pain.

Treatments that release adhesions, tightness and scar tissue in and around the knee can be a great help in cases of patellofemoral knee pain syndrome. Treatments of this nature are designed to improve movement of the patella as it tracks on the femure during activity.

Treatments that stretch the major muscle groups of the leg can bring relief for many people struggling with patellofemoral pain syndrome. The most common form this approach takes is foam rolling. This approach is excellent but should not be used in isolation, its effects tend to be a little too temporary when it used in isolation, it can become quite time consuming.

Patellofemoral Pain Syndrome – Rehabilitation

Longer term rehabilitation of patellofemoral pain syndrome is largely about alignment and strength. Approaches that increase strength and improve biomechanical alignment are the key to resolving tracking issues in the knee. Strength based rehab exercises that usually involve balancing and the use of bands, improvements in walking and running posture, correct footwear and custom orthotic prescription are all qualifying interventions for this type of approach to resolving patellofemoral knee pain syndrome.

Patellofemoral Pain Syndrome – Conclusion

Your entire quality of life depends on your ability to move, even if you are a programmer by day and a gamer by night you will eventually realise this fact if you have not already. The importance of movement to our quality of life is the reason why it is so important and so worthwhile dealing with conditions like knee pain as soon as they arise.

The good news is that while it may take a bit of time and effort to resolve your patellofemoral knee pain you will get there if you are determined to do so. Having the right support is essential if you are looking for good longer term outcomes. Find a clinical team with the right skills and your best interests at heart and you will find their help to be invaluable on your path back to the full ass-kicking version of yourself.








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