What is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome (PFPS) is a common knee problem that is often seen in people who participate in running and jumping sports. More commonly, it is known as runner's knee or jumper's knee. This is due to the fact that this injury is prevalent among runners and athletes such as volleyball or basketball players who perform a lot of jumping movements. Patellofemoral Pain Syndrome (PFPS) is primarily characterized by pain over the front of the knee, but it can also appear in other places. Sometimes it can present above or below the kneecap, behind the kneecap, or even behind the knee.

What are common signs and symptoms of PFPS?

Patients usually present with pain around or behind the kneecap. Pain often presents as an ache in nature but can also be sharp with certain movements or positions.

Pain is often aggravated by activities that increase patellofemoral compressive forces such as going up or down stairs, sitting for long periods of time, kneeling and squatting. Occasionally one might experience a feeling that their knee may give way or buckle on them. Some may also complain of a popping or cracking sensation or sound known as crepitus. This may sometimes be uncomfortable or painful.

What are some ways you can prevent PFPS?

It is important to remember that regardless of what your sport or activity is, it is important to include strengthening as part of your routine to help allow you to perform your activity safely!

During your strengthening it is important to make sure you are executing your exercises using proper technique and form to avoid injury. If you have any specific questions, ask your physiotherapist for help on how you can correct or perfect your form.

Prior to running or any activity, make sure you warm up and get your body ready to go! After you are done with your activity make sure you allow time for a cool down and stretch to help your muscles recover properly. This can help to maintain flexibility and prevent muscles from tightening up. If you are new to running or trying a new activity for the first time, it is a good idea to gradually progress the intensity and not dive in too quickly. This point is important in preventing all kinds of injuries. Lastly, proper footwear is important to provide you with the best support for the activity you are participating in. For more information on what the best footwear for you is, ask your physiotherapist or shoe fitting professional. Since everyone is different, it is always a good idea to get help with finding the shoe that best fits your feet!

What are some common causes of PFPS?

Typically, pain develops gradually and may worsen over time, but it is also possible for pain to arise from a single incident (such as a direct blow or trauma to the patella like falling and landing right on your kneecap). Some other causes include repetitive use or overload of the joint, muscular weakness (specifically of the hip abductor muscles or quadriceps), and muscle tightness (usually of the quadriceps and muscles around the hips) . Malalignment of the lower extremity, which can present in several different ways can also contribute to patellofemoral pain. These can include people with flat feet (pes planus), high arches (pes cavus), or an increased Q angle which most people would recognize as someone who is ‘knock kneed’. These different variations in people's builds can place stress on the knee in different ways and through overuse or repetitive movements can contribute to patellofemoral knee pain.

Anatomy of the Knee

The knee joint consists of three bones and two joints. The three bones that make up the knee are the femur (thigh bone), the tibia (shin bone), or the patella (kneecap). The tibial-femoral joint is the joint between your tibia (shin) on the femur (thigh) and the patella-femoral joint is the surface between your femur (thigh) and the patella (kneecap). The knee is made up of many surrounding muscles and ligaments that assist to stabilize the joint as well as aid in its movement. The primary actions of the knee are flexion, which is bending of the knee, and extension, which is straightening of the knee.

The patellofemoral joint is the articulation between the patella (kneecap) and the femur (thigh bone). It is a modified plane joint which is a joint that allows only gliding movements between the joint surfaces. The patella, which is a triangular shaped bone, is embedded in a thick tendon called the patellar tendon. A tendon is what attaches muscle to bone in this case attaches the quadriceps muscles, which is the group of muscles on the front of your thigh to the tibia or shin bone. During movement of your knee and as a result of contraction and relaxation of the quadricep muscles, the patella will glide over the femur. If there is incorrect alignment of the patella as it glides or tracks up and down, it can lead to pain in the knee.

How can we take care of your knee pain?

Treatment will vary based on how the patient is presenting in the clinic and will depend on the underlying causes and contributing factors that they are presenting with. Generally, rest and activity modification will be prescribed. Ice, taping or bracing and/or orthotics may be prescribed if needed. More common treatment approaches are strengthening and stretching of the muscles identified in the assessment. Often, target areas for strengthening are the hip abductors and the quadriceps. For stretching focus is often on the glute muscles, quadriceps, hamstrings and calves. When the patient is seen in the clinic other treatment options such as manual or hands on therapy and modalities may be used.

Knee pain can be a nuisance and disrupt our daily lives as it can impact walking and running. There are various types of knee pains and knowing which type you are experiencing can help you find the right treatments to manage your symptoms.

With an integrated team of Chiropractors, Physiotherapists, Registered Massage Therapists, Acupuncturists and Kinesiologists, we have you covered for your knee-related problems.

Seeing different practitioners can be helpful as there may be various reasons for your elbow pains. Treatments in a multidisciplinary clinic can help address underlying issues from multiple aspects.

A combination of different treatments can include:
● Soft tissue manipulation to address muscle tightness and trigger points
● Stretching and exercise to manage between treatments
● Chiropractic adjustments to help with stiff joints in the knee, ankle and hip
● Acupuncture and massage therapy to decrease stress in the knee area

If your condition does require further testing or treatment, we can refer you to one of the trusted specialists that we have in our network.

You don’t have to live with knee pain

To summarize, knee pain is common but manageable. Despite there being various reasons why someone can have elbow pain, finding the right modalities and practitioners can help you address the underlying problem and decrease symptoms.

If you resonate with any of these points, give Baseline a call or go online and book an appointment with one of our practitioners.

Written by: Jamie Sonego, Physiotherapist, Vancouver