Patellofemoral Pain Syndrome

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(also known as “Runners Knee”, Chondromalacia patellae or Patella mal-tracking syndrome)

What is it?

Kneecap (or patellar) pain is one of the most common complaints of sports participants. Pain arises from the joint between the back of the patella and the underlying groove in the thigh bone (femur). The surrounding soft tissues can sometimes also be affected.

How does it happen?

It is an overuse syndrome resulting in irritation of the under-surface of the patella. As the knee is bent and straightened the patella slides up and down within a groove at the front of the femur. Quite large forces are generated in this region during sports involving running (particularly downhill) and jumping. This repetitive movement can cause rubbing and irritation of the cartilage and the underlying bone that the cartilage is fused to at the back of the kneecap resulting in inflammation, splitting and de-lamination, then pain and sometimes swelling, particularly if there is joint surface cartilage damage.

How does it feel?

The main sensation is pain felt behind and around the kneecap (front of the knee). It is commonly aggravated by running, going down stairs, sitting for long periods with a bent knee and sometimes even walking. There may be noticeable grinding noises as the patella glides through its groove and sometimes even swelling at times.

What are the causes?

It is often triggered by overuse, such as an increase in volume or intensity of training. There are however usually other factors that predispose someone to getting symptoms including:

  • muscle weakness or imbalance
  • joint dysfunction
  • variations in anatomy/biomechanics (narrow groove, wide hips, asymmetrical patella, knock knees, tibial torsion, flat feet)

How is it treated?

The main aims are to reduce inflammation and pain in the immediate phase, however the most important aspect is to identify and correct the causes. If these are not addressed then patellofemoral syndrome frequently does not get better on its own, especially if continuing your sport/activity.

Input from a sports physiotherapist or sports physician to both confirm the diagnosis and plan treatment is often necessary. This will often incorporate stretching (ITB, Achilles, hamstring, quads) and strengthening exercises (vastus medialis – inner part of quadriceps, and gluteus medius muscle on the upper outer thigh to improve kneecap tracking). Other techniques such as taping of the patella and sometimes using corrective orthotics may be useful. In some cases surgical release of the iliotibial band or realignment of the patella surgically may be necessary, but this is rarely the case.

What can help in the short-term?

Avoiding activities that cause pain as much as possible will allow the symptoms to settle in the short term. In particular avoid sitting with knees bent for long periods, squatting, too many stairs and kneeling activities. Ice applied twice a day or after activity will help. Anti-inflammatory medication can help to improve the pain temporarily. It is very important, however, to make the correct diagnosis as the treatment is often very different for various conditions around the front of the knee. This is why a sports physician assessment is important.