By Sydney CBD Osteopath Dr Abbey Davidson
What is patellofemoral pain syndrome?
Are you experiencing knee grinding or clicking while running or exercising? Pain behind the knee cap? Worsening when going up stairs or even sitting for long periods of time? You may be experiencing Patellofemoral Pain Syndrome or Patella Tracking Disorder. This condition is commonly referred to as Runner’s or Jumper’s Knee as people who participate in running and jumping sports are commonly susceptible to this type of injury.
This article reviews the anatomy, causes, signs and symptoms, treatment/management options and the expected outcomes of Patellofemoral Pain Syndrome.
The knee Joint is a hinge joint made up of the femur and tibia meeting and the knee cap or patella. The patella sits on the front surface of the joint shielding the important structures within. As you bend your knee the pressure between the back side of the patella and the front side of the femur increases. Even a slight “mis-tracking” or poor alignment of the patella through this groove can result in pain sensation behind the knee cap and popping, clicking or grinding symptoms.
Misalignment of the patella through the femoral condyles results in friction, inflammation and clicking, popping and grinding sensations.
“Mis-tracking” of the patella can be caused by biomechanical and range of motion restrictions in the hip/ankle/foot or muscular imbalances through the thigh. The patella is connected to the quadriceps muscles via the quadriceps tendon. Muscular tightness and biomechanical issues in the lower limb can alter the way the patella runs through the femoral condyles resulting in friction and if prolonged can result in damage to the back side of the knee cap as it travels through the condyles of the femur.
Patellofemoral tracking pain is an over use type injury. If your knee pain has come on recently due to an acute trauma or injury, we recommend getting assessed by a health professional as soon as possible.
Patellofemoral pain syndrome is often associated with a sudden change in physical activity (increased intensity or frequency of exercise).
Sign and Symptoms:
Someone suffering patella tracking issues may experience some or all of the following:
- Front knee or knee cap pain
- Pain aggravated with activity (climbing stairs, running, jumping, squatting)
- Pain aggravated with prolonged sitting
- Clicking, popping or grinding sensation in the knee
It is advisable that if your symptoms are progressively worsening or changing to have your knee assessed by a health professional such as an osteopath or physiotherapist.
What you can do right now:
Consider resting, icing, maintaining a healthy weight, assessing your footwear and taping of the area (video below) if you believe you are suffering from patellofemoral pain syndrome. If any of these tips do not improve or aggravate your symptoms please seek professional assessment as soon as possible.
Rest. Being an over use type injury continuing your normal exercise routine will continue to inflame underneath the knee cap and can lead to a progression or prolongation of symptoms. Change to low-impact activities to give your knees a rest. Trial swimming or biking to remain active while placing minimal strain on the patellofemoral joint.
Ice after activity. If it is difficult for you to rest try icing the knee cap for 10-20 minutes directly after an aggravating activity. Avoid direct contract with your skin. This will aim to reduce inflammation and welling at the knee.
Maintaining a healthy weight is key to knee heath. Being overweight places a substantial amount of stress on the knee joints. Losing weight results in a four-fold reduction in load placed on the knees (1kg lost results in 4kg less load through the knee joint).
Check your footwear. Wearing poor or inappropriate footwear during exercise or while at work can place extra stress on the knee and provide little support to the ankle, knee and hip joint. Ensure your footwear is activity specific and not too old or worn.
Taping may provide short term relief of your clicking, popping, grinding or pain. Below is a simple video demonstration of a taping technique which you may find useful. However, if your knee pain is not resolving we do recommend getting a proper assessment by an osteopath, physiotherapist or other health professional.
What your health professional will do:
Assess, diagnose, treat and manage.
Your osteopath, physiotherapist or other health professional will perform range of range of motion, muscular and orthopaedic testing on the knee and surrounding joints. The low back, hips, ankles and feet will all be looked at to ensure the knees are not under excess pressure. Just because the knee is the main site of pain does not mean restrictions elsewhere aren’t contributing to the injury and effecting your recovery. Your osteopath or physiotherapist will try and reproduce your pain and explain your diagnosis to you. Occasionally they will refer you for imaging to confirm what is going on in your knee.
Treatment with hands on therapy will aim to restore normal joint range of motion in the foot, ankle, knee and hip joints. Quadriceps, hamstring and glute/ITB muscle work will also play an important role in your recovery. Prescription of advice and exercises specific for you, your knees and health level will also be performed.
Full recovery from patellofemoral pain syndrome following conservative management is supported by current scientific evidence.
Following professional advice, prescribed treatment and exercise rehabilitation from an osteopath, physiotherapist or other health professional; sufferers can see resolution of pain within 6 weeks. Generally, the longer the symptoms of patellofemoral pain syndrome have been present the longer treatment can take.
Prolonged mis-alignment of the patella and associated friction behind the knee cap left unmanaged can have longer term negative effects. Progression to chondromalacia patella, instability, dislocation, tendonitis, chronic pain or further injury to the knee/leg can occur.
After the trial of conservative methods some rare cases may require surgery.