Do you have pain in the front of your knee?

Patellofemoral pain syndrome (PFPS) is one of the most common knee complaints of both the young and elderly. It is used to describe conditions of pain in and around the patella (knee cap) where the patella articulates with the femur (thigh bone) to form the patellofemoral joint. The undersurface of the patella is ridged, not flat, and needs to glide smoothly up and down the femoral groove as the knee bends and straightens. Imagine a “u” trying to glide up and down inside of a “U” without rubbing on the sides.When the patella doesn’t move in this groove properly it is called maltracking, causing pain and dysfunction.

What causes patella maltracking?

The quadriceps muscle group on the front of the thigh consists of four muscles that connect to the quadriceps tendon, and then to the patella. If there is an imbalance of strength or coordination of the bigger vastus lateralis (VL) on the outside of the thigh relative to the smaller vastus medialis oblique (VMO) on the inside of the thigh it can cause the patella to be pulled outwards as the knee bends and straightens. This can cause rubbing of the sensitive cartilage and bony surfaces of the patella and the femur with repetitive use – leading to inflammation and pain. Other factors that can lead to maltracking include weak hip muscles that control the femur, which goes on to articulate with the knee joint. Other biomechanical patterns such as “knock knees” and “flat feet” (amongst others) can also influence knee alignment and therefore patella tracking. What are the symptoms of patellofemoral pain syndrome? The onset of PFPS tends to occur gradually, with repetitive movements such as stairs, squats, running, or jumping. As the condition progresses it can also be painful when walking, or even at rest. Some people also experience pain when the knee is bent for long periods such as when sitting in a chair.

Patellofemoral pain treatment

Treatment of PFPS is quite complex, and requires a full assessment of the lower limb alignment, control, and strength. Core strength and pelvic control are also observed. Treatment needs to be individualised as there is no recipe for treating PFPS. The goals of treatment are to reduce pain and inflammation in the short-term, and then improve function in the long term with the ultimate goal of achieving ideal patella tracking, muscle balance, and lower limb control. Research has shown that treatments aimed at improving pain and inflammation only have poor outcomes, as the underlying abnormalities remain – causing a cycle of pain and inflammation.