A common source of knee pain, especially in adolescents, comes from the patello-femoral joint. As there are multiple factors that contribute to this pain at the front of the knee, this condition is termed as patella-femoral pain syndrome (PFPS).
A 2016 consensus statement defined PFPS as “pain around/behind the patella (kneecap) that is aggravated by at least one activity that loads the patella during weight-bearing on a flexed knee.” This simply translates to pain at the kneecap during activities such as getting up from prolonged sitting, squatting, running, hopping, & taking the stairs. 🏋️
PFPS is also called runner’s knee, anterior knee pain, & historically has included chondromalacia patellae (CMP), although CMP specifically refers to softening of the cartilage under the patella.
The main causes of PFPS are:
1️⃣ overload/overuse due to sudden increase or changes in physical activities
2️⃣ changes in footwear or playing surfaces causing change in load distributions to the knee
3️⃣ poor lower limb biomechanics causing poor patellar tracking
The patella is a triangular shaped bone that has to glide & “track” the femur bone during movements. It also acts as a fulcrum for our knee extensor mechanism. In PFPS however, the patella does not track the femur properly, commonly translating too much laterally, creating overpressure or irritation to certain areas, resulting in pain.
Patellar tracking differs in individuals, & can be affected by
🔹individual anatomy differences or patellar orientation
🔹foot posture differences
The most common muscular dysfunctions seen in PFPS are: imbalanced quadriceps muscles, weak hip muscles, tight iliotibial band (or rather, the muscle fibers that attach to the ITB), tight hamstrings & calf. Any of this can result in a dynamic valgus movement pattern, causing the patella to mal-track.
Not to worry…as most of these are modifiable, so you can prevent or improve your symptoms! A physiotherapist can assess & prescribe the right exercises for you, provide manual therapy or modalities, advise on training programme or timeline, & teach taping techniques.
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📝1. Crossley, K. M., van Middelkoop, M., Callaghan, M. J., Collins, N. J., Rathleff, M. S., & Barton, C. J. (2016). 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). British journal of sports medicine, 50(14), 844-852.
📝2. Petersen, W., Rembitzki, I., & Liebau, C. (2017). Patellofemoral pain in athletes. Open access journal of sports medicine, 8, 143–154. https://doi.org/10.2147/OAJSM.S133406
📝3. Gaitonde, D. Y., Ericksen, A., & Robbins, R. C. (2019). Patellofemoral pain syndrome. American family physician, 99(2), 88-94.
📝4. Wilczyński, B., Zorena, K., & Ślęzak, D. (2020). Dynamic Knee Valgus in Single-Leg Movement Tasks. Potentially Modifiable Factors and Exercise Training Options. A Literature Review. International journal of environmental research and public health, 17(21), 8208. https://doi.org/10.3390/ijerph17218208
📝5. Mulcahey, M. K., Hettrich, C. M., & Liechti, D. (2020). Patellofemoral Pain Syndrome. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/
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