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Patellofemoral (Kneecap) Pain Syndrome

What is Patellofemoral Pain Syndrome?

(Pain behind your kneecap)

Kneecap pain is one of the most common complaints of sportspeople and the elderly. It usually involves the kneecap (known as "patella") as well as surrounding soft tissue. The pain syndrome, known as patellofemoral pain syndrome, is mostly due to abnormal joint pressure or position that in time affects the joint surface behind the kneecap.

What are the Symptoms of Patellofemoral Pain Syndrome?

Activities that involve a knee bending, especially when fully weight-bearing, will reproduce symptoms.

Kneeling, squatting, running, sitting in a theatre (“movie-goers knee”) or climbing stairs will be painful initially.

Eventually your knee will become painful while walking and then ultimately even at rest.

How Does Physiotherapy Help Patellofemoral Pain?

Scientific research has confirmed that physiotherapy intervention is the most effective long-term solution for kneecap pain.

Approximately 90% of patello-femoral syndroem sufferers will be pain-free within six weeks of starting a physiotherapist guided rehabilitation program.

For those who fails to respond, surgery may be required to repair any severely damaged joint surfaces.

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What Causes Patellofemoral Pain?

The patella (kneecap) is a moving bone that glides up and down a groove in the front of the thigh bone (femur). The quadriceps (thigh) muscles attach to the patella and over it to the patella tendon, the tendon that goes from the base of the patella to the top of your shin.

The kneecap normally glides up and down through the femoral groove. As the knee is bent, pressure between the kneecap and the groove increases. Prolonging and/or repeatedly causing this increased pressure can lead to irritation of the kneecap’s joint surface which in turn causes an inflammatory response.

This pressure is further increased if the patella does not ride properly through the groove, but “tracks”, meaning it travels more to one side, making it closer to the femur. This is the case if there is a muscle imbalance between the lateral quadriceps muscles, which pull the patella up and outwards, and the vastus medialis oblique, which is the only quadriceps muscle that pulls up and slightly in.

If the vastus medialis oblique (VMO) is weak from injury or disuse, the outward pull from the other muscles can result in kneecap tracking laterally. The inflammation causes pain, swelling and may lead to roughening and eventually cracks in the cartilage covering of the kneecap’s joint surfaced.

Patellofemoral Pain Treatments

The aim of treatment is to reduce inflammation in the short-term and, more importantly, correct the cause in the long-term.

Rest - avoid any activity that causes pain. Continuing painful activity will aggravate the condition.

In particular, avoid:
- sitting with knees bent
- squatting
- stairs
- kneeling, i.e. any bent knee activity
Ice applications twice daily and after any activity