Patellofemoral Syndrome

Patellofemoral syndrome is pain at the front of the knee. It is commonly found in athletes who put heavy stress on their knees, and is commonly known as runner’s knee.

What is patellofemoral pain syndrome?

Patellofemoral pain syndrome is pain behind the kneecap. It has been given many names,
including patellofemoral disorder, patellar malalignment, runner’s knee, and chondromalacia.

How does it occur?

Patellofemoral pain syndrome can occur from overuse of the knee in sports and activities such as running, walking, jumping, or bicycling. The kneecap (patella) is attached to the large group of muscles in the thigh called the quadriceps. It is also attached to the shin bone by the patellar tendon. The kneecap fits into grooves in the end of the thigh bone (femur) called the femoral condyle. With repeated bending and straightening of the knee, you can irritate the inside surface of the kneecap and cause pain.

Patellofemoral pain syndrome also may result from the way your hips, legs, knees, or feet are aligned. This alignment problem can be caused by your having wide hips or underdeveloped thigh muscles, being knockkneed, or having feet with arches that collapse when walking or running (a condition called overpronation).

Symptoms

The main symptom is pain behind the kneecap. You may have pain when you walk, run, or sit for a long time. The pain is generally worse when walking downhill or down stairs. Your knee may swell at times. You may feel or hear snapping, popping, or grinding in the knee.

Diagnosis

Your health care provider will review your symptoms, examine your knee, and may order knee x-rays.

Treatment

Initial treatment includes the following easy to remember acronym, LUSKIN:

Once you are able to walk without pain or a limp, you may begin the following exercises:

Standing Calf Stretch
Facing a wall, put your hands against the wall at about eye level. Keep the uninjured leg forward and your injured leg back about 12 to 18 inches behind your uninjured leg. Keep your injured leg straight and your heel on the floor and keep your toes pointed towards the wall. Next, do a slight lunge by bending the knee of the forward leg. Lean into the wall until you feel a stretch in your calf muscle. Hold this position for 30 to 60 seconds, and repeat three times.

Half Kneeling Ankle Mobility
Begin in a half-kneeling position with your forward foot a few inches away from the base of a wall. Shift your weight forward, pushing your knee toward the wall as far as you can. Hold, then relax and repeat. Make sure to maintain your balance and move only through a pain-free range of motion.

Hamstring Stretch
Lie on your back and bring the affected leg towards your chest. Grab the back of your thigh and try to extend your leg. Hold this position for 30 to 60 seconds, feeling a stretch in the back of your thigh. Repeat three times. You may also try this with a towel around your foot if it is more comfortable.

Quadriceps Stretch
Stand sideways to a wall, about an arm’s length away from the wall, with your injured leg towards the outside. Facing straight ahead, keep the hand nearest the wall against the wall for support. With your other hand, grasp the ankle of your injured leg and pull your heel up toward your buttocks. Do not arch or twist your back. Hold this position for 30 seconds. Repeat three times. This may also be done while lying on the opposite side and grasping the ankle of the affected leg. Do not arch or twist your back. Hold this position for 30 seconds. Repeat three times.

Quadriceps Sets
Sit on the floor with your injured leg straight in front of you. Press the back of your knee down while tightening the muscles on the top of your thigh. Hold this position for five seconds. Complete three sets of 10.

Straight Leg Raise
Sit on the floor with the injured leg straight and the other leg bent, foot flat on the floor. Pull the toes of your injured leg toward you as far as you can, while pressing the back of your knee down and tightening the muscles on the top of your thigh. Raise your leg six to eight inches off the floor and hold for five seconds. Slowly lower it back to the floor. Complete three sets of 10.

Abduction
Lie on your uninjured side, leaning on the elbow of your uninjured side and using the arm of the injured side in front of you to stabilize your body. Slowly lift the injured leg up, hold for five seconds, then lower slowly. Be sure to keep your hips steady and don’t roll forwards or backwards. Complete three sets of 10.

Adduction
Lie on your injured side with your top leg bent and flat foot placed in front of the injured leg, which is kept straight. Raise your injured leg as far as you can comfortably and hold it there for five seconds. Keep your hips still while lifting your leg. Hold this position for five seconds, then slowly lower your leg. Complete three sets of 10.

Extension
Lie on your stomach. Raise your injured leg as far as you can comfortably and hold it there for five seconds. Keep your hips still while lifting your leg. Hold this position for five seconds, then slowly lower your leg. Complete three sets of 10.

Bridge with Abduction and Resistance (Aka Banded Bridges)
Start by lying supine on your back with your knees bent to 90 degrees and your feet flat on the floor. Place the tied resistance band just above your knees. Bring your feet and knees apart to hip/shoulder width. You should feel the band trying to bring your knees back together. Keeping tension on the band, press into your heels and lift your hips off the table as high as you can into a bridge position. Hold at the top for 3 to 5 seconds and slowly lower to the starting position. Do not allow the space between your knees to decrease throughout the movement. Repeat for three sets of 10 repetitions.

When can I return to my sport or activity?

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If
you return too soon, you may worsen your injury, which could lead longer healing times. Everyone
recovers at a different rate. Returning to your sport or activity will be determined by how soon your
knee recovers, not by how many days or weeks it has been since pain began. In general, the
longer you have symptoms before you start treatment, the longer it will take to get better.

You may safely return to your sport or activity when, starting from the top of the list and
progressing to the end, each of the following is true:

• You have full range of motion in the injured knee, compared to the uninjured knee
• You have full strength of the injured knee and hip compared to the uninjured knee and
  hip and are able to complete the above exercises without pain
• You can jog straight ahead without pain or limping
• You can sprint straight ahead without pain or limping
• You can jump on both legs without pain, and you can jump on the injured leg without
  pain
  Return to your sport at about 50% effort, and increase by about 10% each week. If you begin with
  pain, you may need to rest for a few days before returning to activities.

Prevention

1. Stay in shape
2. Stretch – Before doing any strenuous activity, do a 5 minute warm up and do stretching
   exercises. Remembering to stretch your knee will help keep the structures around the knee
   flexible and less likely to be irritated by activity
3. Increase training gradually – Dramatic increases in activity over a short period of time can
   result in overuse injuries
4. Use proper running gear – Make sure that your shoes fit properly and provide good support
5. Strengthening of thigh, hip, and trunk muscles – Helps to “off-load” stress on the patellofemoral joint using the above mentioned exercises