April 26, 2017
Patello-femoral pain is experienced around or behind the knee cap. It can occur as an acute injury associated with activities such as running, jumping or stair/hill climbing.
More often than not there is an insidious onset with repetitive low-load activities that stress the patello-femoral joint over a long period of time. And it seems that certain knee, hip and foot characteristics are part of the presentation. Increased ‘turn-in’ at the hip, a ‘valgus’ knee angle, reduction of the inside arch of the foot, or ‘decreased’ flexibility of some muscles are just some of the predisposing factors.
There may be pain on attempting to squat or lunge or step up or down. There could be some swelling, and possibly some obvious thigh muscle wasting. When examining the knee movement the patella will often track laterally rather than staying centred. The quads muscle (particularly the ‘VMO’ on the inside aspect) will have reduced control of the patella. Perhaps there will be associated ITB (iliotibial band) tightness or calf or hip flexor muscle restriction.
The pain experienced can emanate from various structures around the knee, including the menisci, the bone, the patella tendon. But one of the most pain-sensitive structures is the fat-pad below the patella.
Therefore unloading this structure by taping the patella can be a very helpful part of the treatment. Also important is the retraining of the quads (VMO), along with correcting hip muscle control. Certain activities such as moving from sitting to standing or climbing stairs need modifying. Attention to footwear or possibly the addition of orthotics will help correct alignment.
So several issues need to be assessed by your Physiotherapist. An individual programme needs to be devised, and maintenance exercises must be long term.