Injury of the Week - Patellofemoral Pain Syndrome (Runner's knee)

Patellofemoral Pain Syndrome (PFPS)

Patellofemoral pain syndrome is (also known as patellar compression syndrome or commonly, ‘runner’s knee’) characterized by pain around the kneecap that often increases as activity levels increase.

  The patella (knee cap) sits in the femoral (femur is the thigh bone) groove.  The femoral groove is a shallow groove at the bottom of the femur which allows the patella to slide up down, left and right allowing flexion and extension of the leg.  This movement is often referred to as ‘tracking’.   

How does PFPS start?

In a medical study completed by Dixit, Difiori, et al, if patella tracking is off center or being pulled to one side due to a weak quad muscle, overdeveloped hamstring or calf muscles or excessively tight soft tissue, pain will often be felt “behind or around the patella that is increased with running and activities that involve knee flexion”.  This is also common in athletes who over train in their sport(s).  Lastly, gait issues also play a role (i.e. leg length discrepancy, mal-alignment, lack of flexbility in the hips, excessive foot pronation, etc.).

Importantly, according to Sandy Fritz of Sports & Exercise Massage, states “almost all studies of patellofemoral syndrome indicate weakness in the quadriceps, specifically the vastus medialis

Symptoms:

• Dull, aching pain in the front of the knee which increases when squatting
• Pain from prolonged sitting with the knees flexed
• Going down stairs or walking on a downward slope
• Point tenderness on the outside of the kneecap
• Grinding or crepitus when pushing the kneecap into the patellofemoral groove
• Pain when running or jumping  
  

Management:

Rest is helpful in relieving some of the initial pain of PFPS but it will not solve the problem.  If muscle groups are weak or overdeveloped the patella tracking will continue to be an aggravating issue once exercise begins again in earnest. 

For this reason a visit to any of the following experienced practitioners would get you started on the right track towards correcting the issue. 

• Physical Therapist
• Orthopedic Sports Doctor
• Manual Therapist
• Athletic Trainer
• Sports medicine center

A proper strength training program with an experienced athletic trainer will help the athlete properly isolate strengths and weaknesses in the core, hips, legs and gait patterns.  Awareness of the proper areas to work will begin to help the athlete get back to performing at their peak levels. 

In the study by Dixit, Difiori, et al, X-ray and MRI imaging was not recommended as diagnosis can be completed successfully by a trained medical professional without it. 

Massage therapy can be helpful in those with Patellofemoral Pain Syndrome by working the surrounding muscle groups of the knee, especially the IT Band and vastus lateralis. 

Works cited:

• Fritz, Sandy, Sports & Exercise Massage 2005; 555
• Anderson, Hall, Martin, Sports Injury Management; 1^st Ed 1995; 453
• Dixit, Difiori, et al, Management of Patellofemoral Pain Syndrome; Jan 15, 2007; http://www.aafp.org/afp/20070115/194.html