Patellofemoral Pain Syndrome Description Patellofemoral pain syndrome is commonly known as “runner’s knee” and refers to the wearing away of the cartilage on the back surface of the kneecap. The first indication of this condition is usually a “popping” or “grating” sound, and the knee pain is under the kneecap. This condition may result from acute injury to the patella or from chronic friction between the patella and the groove in the femur through which it passes during the motion of the knee. Patients with this condition should avoid activities which will cause further damage to the joint. Common Signs and Symptoms     

General pain in and around the kneecap. Occasionally posterior knee pain occurs. Pain that is usually worse after activity—this includes running, climbing stairs, or squatting exercises. Crunching or cracking sound when the knee is bent. Swelling in the knee and a “tight” feeling in the knee joint. The occasional knee buckling, in which the knee suddenly and unexpectedly gives way and does not support your body weight

Causes      

Kneecap is abnormally aligned causing excessive stress and wear on the cartilage of the kneecap. Overuse or injury Excess body weight Knocked knees Fallen arches or flat feet (pronating foot) Sudden increase in training

Risk Increases With     

Sports that require sudden explosive quadriceps contraction (jumping, quick starts, or kicking) Running sports, especially running down hills Poor physical conditioning (strength and flexibility, such as with weak quadriceps or tight hamstrings) Flat feet Prolonged sitting will become painful for patients with patellofemoral pain

Initial Treatment   

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Activity Modification (avoiding activities that make symptoms worse) Avoid sitting or kneeling in the bent-knee position for long periods of time. Adjust a bicycle or exercise bike to decrease the resistance and adjust the seat to an appropriate height. You should be able to spin the pedals of an exercise bike without shifting weight from side to side, and the knees should not be fully extended at the lowest part of the pedal stroke. Avoid bent-knee exercises, such as squats, deep knee bends, or 90-degree leg extensions. Low arches or flat feet can cause over-pronation or the feet to roll inward causing poor lower extremity mechanics. This can lead to increase stress upon the knee cap (patellofemoral joint). Arch supports may help to improve lower extremity biomechanics.

Medication 

Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

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Pain relievers may be prescribed by your physician. Use only as directed and only as much as you need.

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Topical ointments may be of benefit.

Heat and Cold 

Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage. Cold should be applied for the first 72 hours after initial injury.

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Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak. Do not use heat if inflammation (swelling) is present.

Exercises and Stretching Strengthening of the quadriceps muscles (anterior thigh muscles) and stretching of the hamstring muscles (posterior thigh muscles) are extremity important to stabilize the patella and improve lower extremity mechanics. Maintaining strong quadriceps will aid in decreasing the symptoms and frequency of patellofemoral pain.

Quadriceps Sets - Tighten muscles on top of the thigh by pushing knees down into the table or surface. Hold for 5 seconds. Repeat this exercise about 15-20 times every hour.

Straight Leg Raises - Tighten muscle on the front of the thigh, then lift your leg up about 8-10 inches off of the surface. Make sure that you keep your leg straight and knee locked. Hold for 5 seconds, then lower to the surface slowly, once your leg rests back on the table relax, then repeat. Do 3 sets of 15 for 2-3 sessions per day. Make sure that you perform this exercise on both legs.

Wall Slides- Leaning on wall, slowly flex your knees into a squatting position. Do not go past the point where your thighs are parallel with the ground. (Hint: When you cannot see your toes you have gone far enough.) Hold the squatting position for 3 seconds then extend your knees sliding up the wall to the starting position. Do 3 sets of10-15 for 2-3 sessions per day.

Elliptical Machine and/or Exercise Bike (Recumbent or Statonary) Use as tolerated, Increase both time and resistance. On the bike remember to adjust the seat height to avoid deep knee flexion during pedaling.

Elliptical Machine

Leg Press Exercise

Leg/Knee Extension Exercise

Hip Abductors – Lay on your side. Keeping the up leg’s knee extended, move the up leg up and down as shown in the below diagram. Do 3 sets of10-15 for 2-3 sessions per day.

Exercise Bike

Leg Press – Excellent for quad muscle strengthening. Remember no knee flexion greater than 90° as this can lead to anterior knee pain. Do Not use the leg extension machine as this will aggravate the knees and lead to anterior knee pain.

Hip Adductors – Lay on your side, placing your up hip and knee in the position shown below and move the down leg up and down as shown, keeping the knee extended. Do 3 sets of10-15 for 2-3 sessions per day.

Hamstrings/Adductors Stretching - Sit on the

floor with your legs spread as wide as possible in front of you. Your knees must be straight. Lean over one leg with both hands. Keep your chest upright and reach for your toes. (Position A) Hold this position for 10 seconds. Relax and return to your starting position. Now reach forward between your legs. (Position B) Repeat for Position C. Repeat exercise 3 times, 2 times per day.

Hamstrings, Doorway Stretch - Lie on your back near the

edge of a doorway as shown. Place the leg you are stretching up the wall, keeping your knee straight. Your buttock should be as close to the wall as possible and the other leg should be kept flat on the floor. You should feel a stretch in the back of your thigh. Hold this position for 1015 seconds. Repeat exercise 3 times, 2 times per day