Patello-femoral joint pain – a common cause of knee pain

The patella (knee-cap) is situated at the front of the knee & lies within the tendon of the
quadriceps muscle. The knee cap sits in front of the femur forming a joint in which the bones are almost in contact with each other. The surface of each bone, however, is lined with cartilage to allow cushioning between the bones. This joint is called the patellofemoral joint.

What is patellofemoral pain?

Normally, the patella is aligned in the middle of the patellofemoral joint so that forces applied to the knee cap during activity are evenly distributed. The patella acts like a pulley system for the quadriceps muscles, giving the quadriceps a mechanical advantage by transmitting the forces more efficiently. This enables the knee to withstand the increase force produced during lower limb movements in weight bearing e.g. squatting.

In patients with patellofemoral pain the patella is usually misaligned relative to the femur, which therefore places more stress through the patellofemoral joint during activity. As a result this may cause pain & inflammation to the patellofemoral joint. The misalignment of the patella may occur for various reasons. One of the main causes is an imbalance in strength between the sides of the quadriceps muscle.

Signs & symptoms of patellofemoral pain

  • Pain at the front of the knee, around or under the knee cap
  • Pain (or swelling) is sometimes felt at the back of the knee
  • Typically an ache that may increase to a sharper pain with activity
  • Pain is typically experienced during activities that bend or straighten the knee particularly whilst weight bearing
  • Activities that frequently aggravate symptoms include going up & down stairs or hills, squatting, running or jumping.
  • Occasionally felt whilst sitting with the knee bent for prolonged periods
  • Clicking or grinding sound when bending or straightening the knee
  • May be evidence of quadriceps muscle wasting

Contributing factors to the development of patellofemoral pain

  • Muscle strength imbalances/weakness(especially the vastus medialis & gluteal muscles around the hip)
  • Tightness in specific joints & in specific muscles
  • Poor lower limb biomechanics
  • Excessive or inappropriate training or activity
  • Inappropriate footwear or surfaces
  • Excess weight

Treatment for patellofemoral pain

Most cases of patellofemoral pain settle well with an appropriate physiotherapy programme. This requires careful assessment by the physiotherapist to determine which
factors have contributed to the development of the condition, with subsequent correction of these factors.

Physiotherapy management for patellofemoral pain is vital to ensure an optimal outcome. Patients with patellofemoral pain should perform pain-free flexibility & strengthening exercises as part of their rehabilitation to ensure an optimal outcome. The treating physiotherapist can advise which exercises are most appropriate for the patient.

Treatment may comprise of: soft tissue massage, electrotherapy, taping or bracing to correct patella position, mobilisation, ice or heat treatment, progressive exercises to improve flexibility, balance & strength (especially the vastus medialis, the inside quads muscle), activity modification advice, biomechanical correction, anti-inflammatory advice, & referral to a Dietician where appropriate. If an orthotic is recommended, a referral may
be made to the Podiatrist.

The success rate of treatment for patients with patellofemoral pain is largely dictated by patient compliance. Ignoring symptoms or adopting a ‘no pain, no gain’ attitude is likely to lead to the problem becoming chronic. Immediate, appropriate treatment in patients with patellofemoral pain is essential to ensure a speedy recovery.

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