Patellofemoral Pain Syndrome
By: Katie Kaeck, SPTA
Patellofemoral pain syndrome (PFPS) is dull achy pain surrounding the kneecap. Sometimes called "runner's knee," PFPS is more common in people who participate in sports that involve running and jumping. The knee pain often increases as the PFPS afflicted person runs, walks up or downstairs, sits for long periods, or squats. Rest and ice may be a simple way to help, but if this does not resolve symptoms, then physical therapy may be the next step on the way to recovery. (Mayo Clinic, 2021)
The cause for PFPS is uncertain. It has been associated with running and jumping sports that place repetitive stress on the knee joint. This can cause irritation under the kneecap. Muscle imbalances or weaknesses in the muscles around the knee and hip can cause misalignment of the kneecap, relative to its groove. Inward movement of the knee during a squat has been found to be associated with patellofemoral pain. Injury or trauma to the kneecap, such as a dislocation or fracture, is another causative factor of patellofemoral pain syndrome. Knee surgery, particularly repair to the anterior cruciate ligament, using the patient’s own patellar tendon as a graft, increases the risk of patellofemoral pain. (Mayo Clinic, 2021)
Risk factors for PFPS are: 1) Age; patellofemoral pain syndrome typically affects adolescents and young adults, while knee problems in older populations are more commonly caused by arthritis. 2) Gender: Women are twice as likely as men to develop patellofemoral pain, as a woman's wider pelvis alters the angle at which the bones in the knee joint meet. 3) Participation in running and jumping sports which put extra stress on the knees, especially at increased training levels. (Mayo Clinic, 2021)
Tools for prevention of PFPS include: 1) Maintain strength. The knee is kept balanced during activity by thigh and hip musculature. 2) Alignment and technique. Optimization of running, jumping, and pivoting techniques by physical therapy. 3) Shed weight, as extra pounds increase the forces placed on the knees. 4) Perform a 5-minute pre-activity warm-up. 5) Stretching to aid flexibility. 6) Increasing intensity gradually. 7) Shoe fit. Choose appropriate shoes that absorb shock. (Mayo Clinic, 2021)
Studies on effective exercises: The article: The Effect of Valgus Control Instruction Exercises on Pain, Strength, and Functionality in Active Females With Patellofemoral Pain Syndrome found that valgus control (knock knee prevention) instruction exercise programs were effective in decreasing pain, improving strength, and increasing athlete's functional performance (Emamvirdi, et al, 2019). The article: Short-Term Effects of Hip Abductors and Lateral Rotators Strengthening in Females with Patellofemoral Pain Syndrome: a randomized controlled clinical trial found that both knee and hip strengthening exercises were effective with PFPS patients. These researchers found that hip strengthening had a greater effect on decreasing pain (Fukuda, et al, 2010).
References:
Emamvirdi, M., Letafatkar, A., & Khaleghi Tazji, M. (2019). The Effect of Valgus Control Instruction Exercises on Pain, Strength, and Functionality in Active Females With Patellofemoral Pain Syndrome. Sports health, 11(3), 223–237. https://doi.org/10.1177/1941738119837622
Fukuda, T. Y., Rossetto, F. M., Magalhães, E., Bryk, F. F., Lucareli, P. R., & de Almeida Aparecida Carvalho, N. (2010). Short-Term Effects of Hip Abductors and Lateral Rotators Strengthening in Females with Patellofemoral Pain syndrome: a randomized controlled clinical trial. The Journal of orthopedic and sports physical therapy, 40(11), 736–742. https://doi.org/10.2519/jospt.2010.3246
Mayo Foundation for Medical Education and Research. (2021, February 5). Patellofemoral pain syndrome. Mayo Clinic. Retrieved April 25, 2022, from https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/symptoms-causes/syc-20350792#:~:text=Patellofemoral%20(puh%2Dtel%2Do,that%20involve%20running%20and%20jumping.
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