Patellofemoral Pain Explained

Sarah Cowgill (Physiotherapist – Burnie)

Here at Coastal Physiotherapy we see a lot of people presenting to us with knee complaints. One common cause of knee pain we see is patellofemoral pain. This type of knee pain normally presents with pain around the knee/knee cap region. It can affect people from all walks of life.

How Do I Know If I Have Patellofemoral Pain?

Pain normally is felt at the front and/or around the knee cap. But this can vary depending on the individual.

Just because you have pain in these areas does not fully confirm your pain is patella-femoral pain. There are many other causes of knee pain that have a similar pain pattern. It is good to see one of our Physiotherapists at Coastal Physiotherapy’s Burnie or Somerset clinics to confirm the diagnosis.

It may follow a period of increased loading on the legs e.g. starting an unaccustomed sport/activity or due to a rapid increase in physical activity. It is also often a common complaint post knee surgery due to muscles surrounding the knee not being as strong as they were post operation.

Normally you will not have any locking or giving way of the knee and minimal swelling.

Some activities which often hurt if you have patella femoral pain include:

• Stairs
• Squatting
• Running, jumping, hopping
• Prolonged bending of the knee

What Causes Patellofemoral Pain?

It is believed that patellofemoral pain is caused by mal-alignment of the knee cap on the thigh bone as the knee bends. This causes an increase stress on the knee cap.

Causes of knee cap mal-alignment:

• Weak quadriceps muscle
• Weak gluteal muscles
• Having a wider pelvis (females)
• Tibial bone (shin bone) rotation
• Foot pronation (rolling in)
• Poor core/trunk control

Other factors that can cause patellofemoral pain include:

Training error – When we quickly increase our training amount without the adequate conditioning it can lead to increased loads going through our knees. If our muscles and joints are not use to the force we are putting through them it can lead to issues. It is important to slowly return/start activity. If you are unsure on how fast you should be getting into an activity come and see one of our Physiotherapists or Exercise Physiologists to point you in the right direction.

Poor movement control – Have you ever tried to stand on one leg and ended up wobbling all over the place. This is an example of poor movement control. When our muscles are weak or do not activate at the right time this can lead to our joints moving in different directions which can put extra pressure through the knee. Poor movement control of the trunk, hip, knee, ankle and foot (see picture) can all lead to excess pressure through the patellofemoral joint.

Poor Biomechanics – Biomechanics are the position in which our joints/bones/muscles sit when at rest or during movement. Factors such as the angle between our hip joint and knee, rotation of the femur or shin, depth of the grove the patella sits in and rolling in of the feet can all impact on patella femoral pain. Some of these factors are changeable and some we cannot change.

Poor flexibility – Tightness in the iliotibial band, quads, hamstring and calves all place different loads onto the patella so it is important to maintain flexibility through these areas.

How Do I Fix my Patellofemoral Pain?

Here at Coastal Physiotherapy our Physiotherapists and Exercises Physiologists are very skilled in treating patellofemoral pain.

Our treatment normally resolves around 4 main strategies:

1. Offload the sore joint
2. Identify the causes to your patellofemoral pain (everyone is different)
3. Fix those causes
4. Re-load the joint

This includes doing things such as:

• Providing strategies to modify your activity load
  • Reducing running distances
  • Changing footwear
  • Walking/running on softer grounds
  • Avoiding jumping/squatting activities
• Strengthening program for quadriceps and gluteal muscles
  • We provide a specific rehab program for you
  • Not everyone needs the same exercises
• Taping to assist knee cap tracking
• Walking/running posture retraining
• Manage other pre-disposing factors
• Mobilising your patella
• Stretching
• Education about loading knee again

If you believe you may have patello-femoral pain and would like some help to fix it then come and see one of our highly skilled Physiotherapists or Exercise Physiologists at Coastal Physiotherapy in either Somerset or Burnie and get back into what you love doing!