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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, and
-
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, and
-
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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