Patellofemoral Pain Syndrome

Posted On: May 11, 2020

Pain in the front of the knee around the knee cap (patella) is common. There are multiple causes of this type of pain. The medical profession typically lumps these conditions in a catch-all phrase called patellofemoral pain syndrome.

As a clinician, I am a stickler for detail, and catch-all phrases are seldom very specific. That’s the case with patellofemoral pain syndrome, which translates simply as pain in or around the knee cap and thigh bone.

When patients come to me with this condition, my first job is to figure out what structure is involved. Is the tendon below the patella the pain generator? Does the pain originate from behind the knee cap? Does the pain involve the tissue (fascia) that envelops the knee?

Proper treatment depends on the problem. For example, let’s pick the tendon below the patella known as the patellar tendon. If this tendon is sore and tender it most likely is from too much stress on it during physical activity. The diagnosis would be that of a patellar tendinitis (or tendinosis to be specific).

Now that this has been identified, the clinician has to figure out why it is being overloaded. Are the muscles of the hip weak?  Is the tissue along the outer side of the thigh too tight (a tight iliotibial band)? Is there an unstable ankle from previous injuries? Is there a flat arch of the foot (overpronation)? Did the individual start challenging the tendon more than it was trained to handle?

Often times the problem is multifactorial and it is the clinician’s job to figure out what needs to be addressed in order to manage the problem. This is why, if you have anterior knee pain or have been diagnosed with a patellofemoral syndrome, it is important to see a physical therapist or chiropractor who is experienced in orthopedics and sports injuries.

Let’s say for the sake of argument that our example has all of the factors mentioned. We would likely want to: (1) strengthen the hip; (2) loosen the iliotibial band with stretching or by using a foam roll exercise; (3) strengthen the ankle; (4) prescribe proper shoes and/or orthotics; (5) modify training; and (6) strengthen the thigh muscles (quadriceps) in such a way so as not to over challenge the tendon.

After doing this we would reintegrate that patient into a training regime that allows them to again function at an acceptable level.

It sounds involved, and it is, but if you have this condition do not lose hope. When thoughtfully managed, patellofemoral pain syndrome can nearly always be resolved.

Stay well and be active.

Dr. J