Patellafemoral Pain Syndrome (PFPS) is a relatively common knee dysfunction problem that I see in clinic regularly. While it is common, the varied flavors of the condition make each case unique and sometimes challenging to treat. There are a ton of factors that contribute to the onset of PFPS and therefore no one size fits all solution! In this video blog I will outline some of the more common factors that contribute to the onset of PFPS. I’ll also demonstrate some quick and easy fixes you can try at home. While each case is unique the descriptions below should give you a starting point to understanding and managing this condition.
Medial (inner) quads - there is general consensus in the research that a relative weakness or a delayed onset of the inner quadriceps muscle (known as the Vastus Medialis Obliquus or VMO) relative to the outside quadriceps muscle is a feature of PFPS. For this reason a longstanding treatment approach has been to strengthen the VMO and improve its recruitment to a point where its activation matches the outside counterpart. A simple activation exercise is demonstrated on the video, try this one in the convenience of your home or office and impress all of your friends!
Lateral hamstring - Another commonly identified contributing factor is tightness or adaptive shortening of the outside hamstring muscle (known as the Biceps Femoris). Theoretically, tightness in this muscle can pull the shin into external rotation which will put compressive stress on the outside border of the patella. Stretching of this structure will de-facilitate this potential rotation problem and assist in restoring normal knee mechanics.
Ankle position - Just like good hip alignment is crucial for good knee mechanics, so is ankle alignment. Avoiding overpronation is something that can in most cases can be trained and will help with managing PFPS, not to mention making your walk look stronger. Stand and walk with you feet facing forward, not rotated out to the side. Avoid the duckie foot!
Gluteal strength - We all need strong glutes! For more than just filling out a pair of jeans, the gluteal muscles keep the hip from slipping into an internally rotated and weak position that would result in compression of the patella into the femur. We rely on the glutes to help maintain good movement mechanics through the whole leg and they deserve attention. Resistance training for these muscles is often part of the management strategy for PFPS.
Landing mechanics during run - Minimalist running has been all the rage for a couple of years now and there is some evidence to suggest that striking mid to forefoot when running (not walking) reduces ground reaction forces up the leg that might normally compress the patella into the femur. Plus you get to wear the cool looking minimalist shoes!
Relative tightness in lateral retinaculum - The retinaculum is a band of soft tissue that anchors the patella to the outside aspect of the tibia and fibula on the shin. Tightness of this structure will theoretically pull the patella out of central alignment and compress it into the femur. In the video I show a simple stretching technique to help with this.
Taping - taping is a classic strategy for managing PFPS but is is not without its controversy. The controversy surrounds the fact that taping is essentially a passive brace. Since your body is relying on tape rather than muscle tone for support, it can induce a weakening of the relevant stabilizing musculature around the knee. Still, taping has been shown to help manage pain in acute cases of PFPS and may be an approipriate consideration in the short term.
PFPS is a multifactoral condition that leads to chronic pain around the kneecap. The solution to this problem is equally multifactoral and unique to each case. The discussion above should be seen as a starting point for understanding and managing the condition. If you have specific questions about your situation don’t hesitate to contact me!
Further reading on PFPS
Al-Hakim, W., Jaiswal, P. K., Khan, W., & Johnstone, D. (2012). Suppl 2: The non-operative treatment of anterior knee pain. The open orthopaedics journal, 6, 320.
Halabchi, F., Mazaheri, R., & Seif-Barghi, T. (2013). Patellofemoral pain syndrome and modifiable intrinsic risk factors; how to assess and address?. Asian journal of sports medicine, 4(2), 85.
Cheung, R. T., & Davis, I. S. (2011). Landing pattern modification to improve patellofemoral pain in runners: a case series. journal of orthopaedic & sports physical therapy, 41(12), 914-919.
Collado, H., & Fredericson, M. (2010). Patellofemoral pain syndrome. Clinics in sports medicine, 29(3), 379-398.
Cowan, S. M., Bennell, K. L., Hodges, P. W., Crossley, K. M., & McConnell, J. (2001). Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Archives of physical medicine and rehabilitation, 82(2), 183-189.