What is Patellofemoral Pain Syndrome?
What Could Be Causing My Knee Pain?
When you Google “knee pain” there is a wide range of diagnoses you may find. Some have clear predisposing factors. For example, if you are a 16 year old soccer player who pivoted on the field and felt a pop, you might be leaning towards a ligamentous injury, whereas if you are a 62 year old who’s pain has been gradually worsening over the years you may be thinking something degenerative in nature- like osteoarthritis.
A less commonly known, but very prevalent problem is known as patellofemoral pain, or PFPS (patellofemoral pain syndrome). To break this down: patella is the anatomical term for kneecap, and femoral refers to the groove of your femur (or thigh bone) that your kneecap fits nicely into. As we bend and straighten our knee, the patella slides up and down within the groove. When we pivot and twist the kneecaps glides medially and laterally (side to side) within the groove. All of these movements are known as tracking and are normal biomechanics of the knee. So the problem arises when we have maltracking (abnormal movements of the patella in the groove) or malpositioning (the patella natural rests in the wrong place).
In order to relieve the pain we have to figure out the cause, many of which are completely treatable. One of the most common reasons for maltracking is an imbalance of the soft tissues. Some things are too tight and overpowering. Some things are too loose and weak. So as you try to move, the patella gets pulled towards the tighter side. As a very generalized statement, most people tend to be tighter on the outside of the thigh/knee and weaker on the inside. Posture is almost a common contributing factor. If you’ve heard of the term pronation, you know this causes the foot to flatten or roll inward. This causes a chain reaction of making the shin bone and thigh bone (tibia and femur, respectively) rotate in as well. Meaning the knee will rotate in as well. Now we have an abnormal force on the patella that will lead to breakdown and pain. On a similar note, many of us do not properly strengthen our hips. If the hip muscles that hold our legs in neutral are too weak, again the thigh will rotate in and cause the same problem of malpositioning discussed above.
With that said, we now have several fairly easy treatments to consider. Working on strengthening of the ankle and arch of the foot, along with getting an orthotic can help with foot posturing. Strengthening the hip muscles can help to hold our legs in proper alignment as well. If PFPS is the result of muscle imbalance, we can release some muscles (commonly hamstrings, calf and outer thigh) and strengthen the opposing muscles (commonly quadriceps, hip musculature). Pain management is often coupled with these methods and can include ice, anti inflammatories and kinesiotaping/McConnell taping.
Of course there can be more serious issues including instability, degeneration, etc, so if trying some of these techniques do not help it may be wise to see a physician or physical therapist to take a more in depth look. If are having issues, feel free to reach out to The Centers For Advanced Orthopaedics- MMI Division. We are here to help you with all of your musculoskeletal needs. Our experts want to help you get back to the activities you love. Visit mmidocs.com or call 301-694-8311 today for your appointment. We have telemedicine and in office appointments available to fit your every need.