Patellofemoral Pain: Causes and Treatment

Patellofemoral pain syndrome is a common condition that causes pain under or around the kneecap. If the patella mistracks in the femoral trochlear groove, located on the  femur underneath the patella, it can cause soft tissue irritation, excess wear, and pain.  This can be triggered by a variety of factors including overuse/overload, biomechanical problems, and/or muscular dysfunction.  Typically, patients with patellofemoral pain syndrome have anterior knee pain that occurs with activity and often worsens when descending steps or hills, running, negotiating uneven surfaces, kneeling, squatting, and even with prolonged sitting.

Causes

Overuse/Overload: Each time you bend your knee, pressure is created between the patella and the femur.  This repeated pressure can cause patellofemoral degeneration and pain.

Biomechanical Problems: Patients with flat feet may experience internal or external rotation of the tibia or femur.  This compensatory movement disrupts the patellofemoral mechanism, thereby causing maltracking.

An increased Q angle is another potential contributing factor to patellar dysfunction.  The Q angle is the angle formed by a line drawn from the hip to the center of the patella and a second line drawn from center of the patella to the center of the tibia (leg bone).  Women typically have wider hips, and therefore, larger Q angles, and hence are at more risk for patellofemoral pain.

Muscular Dysfunction: Two potential muscular causes are weakness and inflexibility. Weakness of the quadriceps muscles is of greatest concern, but a weak VMO muscle (Vastus Medialis Obliques), or tightness in the iliotibial band, hamstring, or calf can also be contributing factors.

Treatment

An initial conservative approach to patients with patellofemoral pain syndrome typically includes the following:

• Rest: One way to reduce patellofemoral pain is to take a break from impact activities such as running, volleyball, or basketball. Instead, try swimming, biking or another low-impact activity
• Strength training: Your quad muscles control the movement of your kneecap, so increase the strength of your quads by doing straight leg lifts and shallow knee bends
• Stretch: Muscle stiffness can cause abnormal tension on the patella, so ensure the hamstrings, quadriceps, calves, and hips are flexible.
• Footwear: Wear good shoes or orthotics. Proper walking or running shoes with good shock absorption can help knee pain. Even a simple arch support insert from a shoe store can be helpful.
• Ice: Ice your knees for 10 to 20 minutes after activity. This can ease the pain and speed up healing
• Bracing: Wear a knee brace designed to help with patellofemoral pain such as the BREG PTO.  These braces apply lateral compression to the patella, helping it track properly, thus controlling patella subluxation