“Just thought I would let you know that I had a very successful weeks skiing in Verbier and got back last weekend. Weather fantastic and knee held up very well. Many, many thanks.”
Patellofemoral Pain Syndrome
Patellofemoral pain syndrome is a common cause of pain around the front of the knee. It happens when your kneecap (patella) and cartilage in your joint is affected by imbalances in the muscles or wear/damage to the articular cartilage behind the kneecap or in the groove in which the kneecap runs called the trochlear groove. It usually gets better with simple treatments such as physiotherapy and exercises. You may need to adjust your training programme if you do a lot of sport.
What causes Patellofemoral Pain?
It is probably due to a combination of different factors which put extra strain on the knee joint and on the surrounding muscles and ligaments.
The most common cause is overuse of the knee, associated with certain sports such as running, particularly at times of increased training. Some people may have a slight problem in the alignment of the knee; this may cause excessive stress on one part of the patella-femoral joint. The pain may also be due to the way the knee has developed or it may be due to an imbalance in the muscles around the knee. If one side of the quadriceps muscles pulls harder than the other side, then the patella may not glide correctly and may rub on one side.
Foot problems can play a part, for example, where the feet do not have strong arches (flat feet). This makes the foot roll inwards (pronate), which means the knee has to compensate for the inward movement.
Symptoms include pain around the knee. The pain is felt at the front of the knee, around or behind the kneecap. Often, the exact site of the pain cannot be pinpointed; instead the pain is felt vaguely at the front of the knee.
The pain may come and go and is typically worse when going up or down stairs or with certain sports. Also, it may be brought on by sitting still for long periods. There may be a grating or grinding feeling or noise when the knee moves. This is called crepitus. Sometimes there is fullness or swelling around the patella.
What is the treatment for patellofemoral pain?
You will be advised to avoid strenuous use of the knee – until the pain eases. Symptoms usually improve in time if the knee is not overused. Aim to keep fit, but to reduce the specific activities which cause the pain.
In the longer term, certain treatments aim to correct some of the underlying causes – for example, by strengthening muscles and helping with foot problems. Treatments include:
Physiotherapy – improving the strength of the muscles around the knee will ease the stress on the knee. Also, specific exercises may help to correct problems with alignment and muscle balance around the knee. For example, you may be encouraged to do exercises which strengthen the inner side of the quadriceps muscle. You may also be taught exercises to stretch tight ligaments. The specialist physiotherapist can give advice tailored to your individual situation.
Taping of the patella – this is a treatment which may reduce pain. It is where adhesive tape is applied over the patella, to alter the alignment or the way the patella moves. Some people find this helpful.
Surgery is not often used for patellofemoral pain. However, it may be helpful in certain situations. For example, surgery to correct the alignment of the patella.