PFPS occurs when the patella (kneecap) rubs on the femur bone underneath. Patellofemoral pain is common in people who do a lot of sport. It can have a number of causes but damage to the cartilage itself cannot directly cause pain because there are no blood vessels or nerves involved. However it can lead onto other problems which in turn result in pain. These include synovitis (inflammation of the synovial membrane or joint lining), erosion of the cartilage and bone under the patella, soft tissues injury or general irritation.
Initial cause of patellofemoral pain syndrome is likely to be overuse. This may be from external factors such as a sudden increase in training, or performing high intensity jumping and knee bending, or it can be from internal factors such as poor patella tracking (the patella moving incorrectly whilst the knee is bending). Identifying the cause is an important part of treatment.
Symptoms and Diagnosis
Symptoms of Patellofemoral pain syndrome consist of an aching pain in the knee joint, particularly at the front of the knee around and under the patella.
There is often tenderness along the inside border of the patella (kneecap) and swelling will sometimes occur after exercise. Patellofemoral pain is often worse when walking up and down hills or after sitting for long periods of time.
Other signs include a click or cracking sound when bending the knee. If the condition has been a problem for some time then there is likely to be wasting of the quadriceps muscles (muscles get weaker due to not being used) as well as tight muscles around the knee joint.
Assessment is usually done by talking to your local health professional. They will ask you some questions about the injury, usually there are no scans needed.
The aims of a patellofemoral pain rehab program is to:
- Decrease pain and inflammation
- Strengthen the weakened muscles of the knee and hip
- Increase flexibility of the tight muscles
- Address the issues that are causing the pain and correct them
Firstly you need to decrease the swelling around the area and ease the pain. This is done by applying ice are compressing the area. Ice may be applied for 15 minutes every 2 hours initially reducing frequency as symptoms start to get better. Compression can be done by simply getting a knee support or brace, these are easily bought off-line or in medical stores.
As there are a lot of different potential causes of this type of pain, we need to find out which one applies to you. This is something that needs to be trialed yourself, try a new pair of good footwear or purchase a orthotic insole for your current pair. You can also see if the surfaces that you are regularly using are causing the pain, try running on a different surface (if you are a regular runner).
Now you can start the main section of the rehabilitation process, strengthening the vastus medialis muscle, this is a muscle that is part of your quadriceps and when it is strong, it will help support and correct the alignment of the kneecap.
Isometric Knee Extension and Flexion
This may be a really easy exercise or quite difficult, depending on how bad the injury is.
- Sit on a chair
- Straighten you leg, making sure that the movement is done very slowly.
- Hold in position for 3 second
- Bring leg back down to floor slowly, and then relax
- Try and do as many as you can, if/when you are achieving 3 sets of 10 without too much discomfort, you can continue to the next exercise.
- This exercise requires a step
- You will need to stand on the step and then slowly lower the uninjured leg off the front of the step until the heel touches the floor.
- If you do this with your un-injured leg straight, you will find that the injured leg will bend slightly, this is exactly what is meant to happen.
- Raise the leg off the ground back on to the step
- Repeat 3 sets of 10.
- Should be started as soon as you are able too, pain free.
- Stand one foot in front of the other, the injured knee forwards.
- Bend the front knee enough to feel the quadricep muscles working. Aim to keep the knee pointing forwards - don't let it fall inwards.
- Return to starting position and repeat.
- Aim for 3 sets of 10 repetitions
- It may be better to perform a number of sets throughout the day, especially in the early stages of rehabilitation.
- Lay on your side with the knees bent at 90 degrees and the feet in line with your spine.
- Lift the top knee away from the bottom knee.
- Make sure you keep the lower back and pelvis still and don't rock backwards.
- You should start to feel the bum muscle and hip muscles working.
- Start with 2 sets of 10 repetitions and gradually increase to 3 sets of 15-20
After you are able to complete these exercises without pain, you can start introducing sport specific training (if applicable). We recommend that you continue to perform lunges and heel drops after rehabilitation has finished as this will aid in preventing future injury.