What is it?
Patellofemoral Syndrome, or PFS for short is basically pain in your knee. Specifically the front of your knee. The name Patellofemoral Syndrome comes from the involvement of both your knee cap (patella) and your thigh bone (femur). The word ‘syndrome‘ really just means ‘a collection of symptoms’, which in this case is primarily pain. PFS pain can be in front, on top or feel like it is ‘behind’ your knee cap.
There are a few common causes of PFS, however none of them are well established as ‘the’ cause. One cause of the pain itself is due to degradation of the cartilage between the patella and the femur. The other common cause of such pain is poor ‘tracking’ of the patella. In other words, your knee cap doesn’t move the way it is supposed to (ie: not on the proper track) when your knee bends or extends.
How can I identify it?
It hurts. The level of pain may depend on causes, and for how long you’ve had the issue. Pain can range from a dull ache to a severe, sharp stab. Pain is typically worst when sitting (with knee bent), squatting, jumping or using stairs. In particular going DOWN stairs is typically most severe. Keep in mind that there are many causes of similar pain, and if the pain does not go away within a few days, it is probably time to go see a medical professional. Thankfully, if it is PFS, it is generally very responsive to conservative treatment.
How can my Doctor/Chiropractor/Physiotherapist identify it?
Your preferred medical professional should be able to identify your condition by performing a few bio-mechanical tests. As mentioned, there are several other conditions with similar signs and symptoms, and a few non-invasive tests are usually adequate to diagnose PFS. Of course, if the cause of PFS needs to be determined exactly, your doctor might recommend X-Ray, CT or MRI imaging.
In rare cases, Arthroscopy may be used to confirm the diagnosis of PFS, as it allows the doctor to see the cartilage surface directly. Arthroscopy can also help assess other similar conditions to PFS, in that doctors can see other joint structures that may cause similar symptoms.
What are causes of PFS?
PFS risk factors include:
- Age: PFS generally is more prevalent in adolescents, as knee pain in older adults is usually associated with arthritis.
- Sex: If you are a female, you are twice as likely to develop patellofemoral syndrome. The reason for this that due to women’s wider hips, the angle at which the bones in the knee joint meet (the Q-angle) is increased.
- Physical Activity: Certain sports increase the risk of PFS, such as those that involve jumping and a lot of running. This is particularly true with increased or elevated training levels.
What actually causes patellofemoral syndrome is not 100% clear, however it has been associated with overuse, physical injury, and excess weight. All of these factors essentially increase the stress on your knee joint.
OK, so what do I do to prevent it?
While knee pain often has a sudden onset, there are a few things that you can do to help prevent it in the first place:
- Maintain Strength: Focus on quadriceps and hip abductors, as they can help maintain knee balance during activity, however weighted deep squats should be avoided.
- Use proper technique: Ask your doctor, chiropractor, or physical therapist about exercises that you can perform to improve your technique for jumping, running and pivoting. The focus here is to avoid having your knee ‘cave inward’ when absorbing impact.
- Lose Excess Pounds: Excess weight causes additional stress on your joints, shedding a few pounds can reduce that stress.
- Warm Up: Before exercise, it is important to prepare your body and your joints for the work ahead. Start with light stretching or low-intensity cardio.
- Increase Intensity Gradually: Be patient with activity level progression. Anywhere that you’ve heard ‘too much, too soon’ might cause an injury? This is one of those injuries.
- Use the Right Footwear: Make sure your shoes fit properly and provide appropriate support for your sport. If you have foot issues, such as flat feet, consider custom-made orthotics.
What are my treatment options?
As with many pain syndromes, usually the first step is to identify activities that aggravate the condition, and begin treatment by limiting these activities.
After performing activities that aggravate the condition, inflammation and swelling can occur. If this is the case, icing can be an effective treatment.
To relieve pain and/or reduce inflammation, over-the-counter pain relievers are an option, such as acetominophen (Tylenol), or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve).
Your physical therapist might recommend:
- Rehabilitation excercises: The idea behind this is to strengthen the muscles that support your knees and control alignment such as quadriceps, hamstrings, and hip abductors. Ultimately the goal here is to correct the inward movement of the knee during squatting.
- Bracing or Orthotics: There are several modern options for knee bracing which help to encourage the patella to track correctly, and/or limit full flexion of the knee. Orthotics may be indicated if foot mechanics are determined to be a factor in causing knee mis-alignment
- Taping: Your physical therapist may show you how to tape your knee to reduce pain and enhance your ability to exercise. This is another way to help your knee cap to track properly.
- Lower-impact exercise: During recovery, it is advisable to participate in activities that do not impact the knee as severely, such as swimming or biking.
It is important to note that while both pain relieving drugs and bracing options may relieve symptoms and improve day-to-day functionality, they do not address the root cause of the problem, which is very often a leg-muscle imbalance.
In the most severe cases, surgery may be an option. Arthroscopic surgery involves the insertion of instruments through a small incision to remove damaged cartilage. Realignment surgery is indicated in only the most rare of cases, and this involves the surgeon realigning the angle of the kneecap, or relieving pressure on the cartilage.
In Summary
Patellofemoral Syndrome, while somewhat common, is also fortunately very treatable. Most treatment options are accessible, inexpensive, and generally do not require surgery. Practicing good, bio-mechanics, as well as staying fit and active have a good success rate for preventing PFS. But if it happens to you anyhow, your local chiropractor is ready to help.
