Patellofemoral joint and tendon pain is a common reason members present for physiotherapy

Patellofemoral of the story

By Lt Genevieve Liebich
Pain at the front of the knee is one of the most common reasons members present for physiotherapy treatment.

Some of the structures that could cause knee pain include the patellofemoral joint (the joint that forms between the knee cap and the thigh bone), the patellar tendon (the tendon between the kneecap and the lower leg bone) and the fat pad that sits beneath the patellar tendon.

This article will expand on a condition called patellofemoral pain syndrome, which involves the patellofemoral joint.
This is described as pain in and around the kneecap (patella).

Patients with patellofemoral pain syndrome usually describe a gradual onset of vague, non-specific pain around their patella.

Often patients have had this pain for a number of months, even years, but can also present after an acute accident, for example, falling on their knee.

This pain often presents after running up and down hills, increased stair work or any activity that requires repeated bending and straightening of the knee, for example, long distance running.

Usually there is wasting of the inner quadriceps muscle and possibly some swelling around the patella.

The knee often clicks as it moves through its range of movement and usually the patient feels and hears grating or crepitus under their kneecap.

This grating noise can be very disconcerting and is one of the biggest reasons, besides pain, that members present for treatment.

Depending on the strength of the inner quadriceps muscle, the knee may feel like it gives way.

Some of the factors that can contribute to this syndrome include:

• Abnormal biomechanics or malalignment of the lower limb for example, increased foot pronation and patella malalignment.
• Soft tissue tightness, including the calves, hamstrings and quadriceps muscles and the connective tissue band, that runs down the outside of your thigh, called the iliotibial band.
• Weak muscles, especially the inner quadriceps and deep buttock muscles.
• Training errors, including running up and down hills and increased stair work.

One of the biggest causes of pain and one of the first things we treat is what is known as abnormal tracking of the patella.

Abnormal tracking results when the patella does not move in the groove that it is designed to move in.

This is due to a combination of the various factors mentioned above.

Treatment of this syndrome is aimed at correction of the factors that contribute to causing pain.

This will include:

• Stretching and release of the tight structures.
• Progressive strengthening of the weak muscles, especially the inner quadriceps and deep buttock muscles
• Correcting any abnormal biomechanics, for example, increased foot pronation.
• Taping the patella into its correct position.
• Correction of any training faults.

In most cases, the symptoms can be relieved with conservative physiotherapy treatment.

• For more information on the cause and treatment of patellofemoral pain syndrome please consult your medical officer or physiotherapist or e-mail me on: genevieve.liebich@defence.gov.au
  Reference: Clinical Sports Medicine (McGraw Hill) 2nd Edition – Brukner and Khan (2000)

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