Patellofemoral Pain Syndrome (PFPS) is the pain located at the front of the knee. This pain starts gradually and has symptoms that increase over the time. It is also known as anterior knee pain. Commonly the patellofemoral pain syndrome occurs if the patella does not move or 'track' in a correct manner when the knee is being flexed and extended. This mal-tracking of the patella causes damage to the surrounding tissues resulting in pain in that region. Individuals who are active in sports and in adolescent girls more commonly suffer from this injury. When bending and straightening the knee, there are several structures surrounding the joint which work together to run the patella in a straight line within the intercondylar groove (made by tibia and femur). Any type of tightness or weakness in the structures causes an imbalance resulting in the patella mal-tracking. Patellofemoral knee pain can also be caused due to a knee injury, if the quadriceps (especially VMO) become inhibited or are considerably weakened.
Symptoms of Patellofemoral Pain Syndrome
- Throbbing pain in the knee joint, mostly at the front, around and under the patella.
- Tenderness present along the inner border of the patella.
- Sometimes any type of activity results in swelling.
- Increasing pain on walking up or down the hills or stairs.
- Bending the knee produces a clicking or cracking sound.
- Sitting for extended periods can be painful or uncomfortable, also known as the "theatre sign" or "movie-goers knee."
- In prolonged or chronic cases there is wasting (atrophy) of the quadriceps muscles.
- The Q-angle is greater than 18-20 degrees.
- Stiffness is present in the muscles, especially calf muscles, hamstrings, quadriceps (especially vastus lateralis) and iliotibial band.
Risk Factors for Patellofemoral Pain Syndrome
- Individuals having a small kneecap or a kneecap which sticks out when the feet roll in or pronate are more likely to develop this condition.
- Individuals having tight muscles are more prone to develop this condition.
- Weak quadriceps muscles are also a contributing factor.
- Individuals involved in sports such as athletes who do plenty of long distance running or hill running are more likely to be affected with this condition.
- Individuals with a previous knee dislocation are more vulnerable to develop this condition.
Treatment for Patellofemoral Pain Syndrome
- Applying RICE (Rest, Ice Compression and Elevation) after activity helps in decreasing pain and swelling.
- Anti-inflammatory medications such as ibuprofen can be given.
- Knee support or heat retainer also helps.
- Orthotic foot supports can also be used.
- Chronic cases which are not benefitting from conservative measures need surgery to release the tight lateral structures.
- Athletes should use the right running shoes which are comfortable.
Physical Therapy Management for Patellofemoral Pain Syndrome
Physical therapist provides exercises and rehabilitation program for your patellofemoral pain syndrome. The first aim of the treatment is to relieve the patellofemoral pain. Physical therapist can use patella taping or bracing and electrotherapeutic modalities with gentle joint mobilization of patella to relief the patellofemoral pain.
Once the pain is relieved, the therapist's next treatment plan is focus on strengthening or stretching exercises of the muscles.
Sit on the floor with extending the leg (having patellofemoral pain) in straight and bent the other leg with foot flat on the floor (as shown in the image). Keep a small folded towel under the knee with patellofemoral pain. Then tighten your thigh muscles of the extended leg by pressing the back of your knee into the folded towel. Hold this position for about 5-10 seconds or as much you feel comfortable, and then rest for up to 10 seconds. Repeat this exercise for 10-20 times at one set and 2-3 times a day.
Straight leg raise
Lie down with your back on the floor with knees bent position and make sure that your feet rest flat on the floor. Then extend straight your leg having patellofemoral pain. While doing this movement your back should maintain normal curve. Tighten your thigh of the extended leg by pressing the back of the knee on the floor. Hold the position and raise your extended leg slowly up so that your heel is off the floor. Maintain 12-18 inches of distance between the heel and floor. Hold the position for 5-10 seconds and lower down your leg slowly. Repeat this exercise for 10-20 times at one set and 2-3 times a day.
Wall Slide with Ball
Stand against the wall with your back and feet. Keep your feet width apart and move a little forward from the wall to maintain some distance between feet and wall. Keep your body in upright position and place a ball between your knees (as shown in the image). Then slowly descent while applying pressure against the ball with your knees until your knees are bent 30 degree. Hold the position for 10-15 seconds or as long as you can. Repeat this exercise for 10-20 times at one set and 2-3 times a day.
Calf Wall Stretch
Stand in front of a wall and keep your hands on the wall (as shown in the image). Keep the affected leg behind the normal leg, with both feet pointed forward and keep the back knee straight with the heel pressed to the floor. Try stretching the calf by pushing the hips forward, while pressing your back heel to ground. Hold the stretch position for 20-30 seconds or as much you feel comfortable. Repeat this exercise for 3-5 times a day.
Hamstring Wall Stretch
Lie down on your back in a doorway, with the buttock against the wall and your unaffected leg through the open door. Place your foot of the affected leg up the wall then try to push the knee straight. You should feel a gentle stretch down the back of your leg. Hold the position for 30-45 seconds. Doing this stretch, don't arch your back and bend your knee. Repeat this exercise for 3-5 times a day.
While standing, hold on to a chair, counter, or wall to assist in balance. Bend your knee (having patellofemoral pain) back by grasping the front of your ankle or foot with one hand (as shown in the image). Pull your foot upward toward your buttocks until you feel a stretch in front of your hip or thigh muscles. While doing this exercise, your knee should be pointed directly to the floor. Hold the stretch position for 20-30 seconds or as much you feel comfortable. Repeat this exercise for 3-5 times a day.