Patellofemoral Pain Syndrome

Patellofemoral pain syndrome is better known as “runner’s knee”, getting the nickname from its high prevalence in runners. This condition affects up to 23% of adults annually, including almost twice as many women as men*. Patellofemoral pain simply means pain present at the point where the patella (kneecap) meets the femur (thigh bone).

The painful symptoms experienced in runner’s knee develop when the kneecap mistracks, so that instead of gliding smoothly in a specific groove at the femur, it moves irregularly and repeatedly rubs against the end of the femur as the knee bends and straightens. This friction causes bony damage, as well as damage to the articular cartilage that covers and protects the joints.

It can be difficult to pinpoint the exact location of the pain within the knee joint but it is often described as being at the front of the knee or behind the kneecap. If you have patellofemoral pain, you may find that your knee pain intensifies when you’re standing and bending your knee (like during squatting), when you’ve been sitting for long periods, when you run or jump, or when you walk down a flight of stairs**. This can make completing everyday tasks and participating in physical activity difficult and painful. Symptoms tend to come on gradually, but as the injury worsens, pain can continue when doing light walking or even resting.

Sources:

*https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190892

**https://pubmed.ncbi.nlm.nih.gov/30633480/

A number of factors are identified that can contribute to the development of patellofemoral pain syndrome. These include muscle imbalances which pull on the kneecap (particularly in the quadriceps, calf muscles and hamstring), alignment, posture and biomechanical problems affecting the feet or legs including having flat feet, training problems like increasing the intensity or duration of your workout without the right preparation, and exercising in unsupportive footwear.

Ultimately, a lot of cases of patellofemoral pain that we see are linked to overuse and repetitive strain, where the knee joint is repeatedly bent and straightened at a higher intensity. This may be paired with a history of knee injury, or a recent direct blow to the kneecap itself.

When it comes to patellofemoral pain affecting more women than men, it may be related to the differences in hormones that affect ligament and muscle function, slight differences in the shape of the bones and women generally having a wider-set pelvis, as well as differences in body composition like a predisposition for women having less lean muscle mass.

If you’re experiencing pain at the back or front of your knee joint, start by limiting movements and activities that bend your knee and aggravate your pain to help you get some temporary relief. You can also try:

• Icing your knee (through a towel or cloth to protect the skin) for no more than 15 minutes at a time, four times per day. This may help reduce your pain and inflammation.
• Using a foam roller on the iliotibial band on the outside of your thigh, and other areas around the knee, this may help relieve muscle tension and improve mobility.
• Switching to supportive footwear, like running shoes with built-in arch support, or your orthotics if you already have a pair from your podiatrist.
• Using a compression bandage or knee brace to help reduce swelling and keep the knee supported while improving blood flow and joint proprioception.
• Using non-steroidal anti-inflammatories to help you manage any pain and swelling.

Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with knee pain, and utilise a range of evidence-based treatment methods to help you get the best outcome. Our goal is not only to make you comfortable now, but to understand the root of the problem so you can exercise and stay active without being held back by knee pain.

Effectively treating patellofemoral knee pain goes far beyond what’s happening solely within the knee joint. During our assessment, we find that we get a lot of answers and insight into the cause of your pain - and how to best treat it - from thoroughly assessing the entire kinetic chain of movement from your foot upwards, which helps us understand where the deficits are present that affect how your knee is moving and being loaded by the body. 

Based on your assessment results, which includes looking at everything from analysing your gait, testing for muscle imbalances, assessing joint stiffness or tightness, analysing your foot posture and more, we’ll present you with treatment options and create a treatment plan for you that will best help meet your goals. This may include:

• Orthotics (insoles): as issues with foot posture and alignment can result in added stress on the knee joint, we may prescribe custom foot orthotics that will work to add the right support to help reduce this stress to best support your recovery. Orthotics have added value in that they continue to work long after you’ve recovered from your knee pain to reduce the likelihood of the problem recurring in the future.
• Footwear recommendations: your footwear plays a vital role in preventing knee pain and injury, supporting your everyday foot health, housing your orthotics, and keeping your legs and feet comfortable. This is why we make custom footwear recommendations and take the time to assess your footwear and answer all of your footwear-related questions. We can also provide advice on sports-specific shoe options to support your running or sports performance, too.
• Strapping or bracing the knee: if required, to offer the best results during the initial stages of healing and pain reduction.
• Activity modification: we want to ensure the activities you’re continuing to do throughout your recovery are supporting your healing, and not making your injury worse. This is where we can discuss your current level of physical activity, as well as the activities you coincidentally perform in everyday life, and ensure it is in line with what is required for an optimal recovery.
• Strengthening and stretching program: stretching and strengthening exercises, particularly those targeting the quadriceps and hamstrings, can help improve knee alignment and reduce stress on the patella. Your program will also include other areas of weakness or tightness identified in your assessment, to help reduce your risk of future injury.
• Gait retraining: we may work with you to help retrain your gait and work on your technique to address biomechanical issues that may be contributing to your pain and injury.