The knee is one of the largest and most important joints in the human body. It allows the lower leg to bend and straighten relative to the thigh as well as supports the body’s weight during everyday activities including standing, walking, jumping and running. The structure and function of the knee joint allows for substantial stability and mobility; however, its repetitive usage and constant loading (i.e., bearing weight) renders it susceptible to increased pain and tenderness. Anterior knee pain, commonly referred to as patellofemoral pain syndrome (PFPS), is one of the most common musculoskeletal conditions seen in family medicine, sports medicine and orthopedic clinics around the world. Although its etiology remains elusive, it is usually defined as pain around the patella (knee cap) that occurs during or after highly-loaded knee bending and extending, leading to impaired function. Symptoms include pain, giving way and clicking, occasionally with swelling and stiffness.
Treatment methods including eccentric quadriceps strengthening (that is, strengthening of the muscles of the front of the thigh while they are lengthening), use of taping techniques to facilitate optimal patella alignment and tracking, proprioceptive neuromuscular facilitation (manual therapy), and improved strength and control globally of the hip and knee muscles lead to positive treatment outcomes.
Patellofemoral pain syndrome can be commonly misdiagnosed as chondromalacia of the patella (softening of the cartilage behind the kneecap), osteochondritis dissecans (cracks in the cartilage and underlying bone), Osgood-Schlatter disease (irritation where the patella tendon meets the shin bone, mostly in adolescents), peripatellar tendonitis or bursitis, and other rarely occurring pathologies. It is essential to conduct a thorough history and physical examination from a skilled physical therapist for proper diagnosis. The goals in the acute phase of PFPS are to reduce pain, minimize patellofemoral joint stress, decrease inflammation and irritation, and prevent muscle atrophy. Beneficial exercises include performing squats in a limited range of motion (from 0 degrees to 45 degrees of knee bend) and performing resisted knee extension (with a band, ankle weights, or a knee extension machine) allowing the knee to slowly lower from 45 degrees of knee bend to 90 degrees to keep patellofemoral joint stress to a minimum.
By James Goodwin, PTA, CSCS