Patellofemoral Pain Syndrome
If you are experiencing pain around your kneecap, you may be experiencing patellofemoral pain syndrome, or also called Runner’s Knee.
What is Patellofemoral Pain Syndrome (A.K.A Runner’s Knee)?
The patellofemoral joint is the connection between your kneecap (patella) and your leg (femur). Patellofemoral Pain Syndrome, or PFPS for short, is pain in the front of the knee or around the patella (kneecap). The hallmark trait of PFPS is intensifying pain with activities like squatting, getting up from the chair, climbing stairs, walking downhill, or even sitting for long periods of time with your knee bent. PFPS does not account for all types of pain in the front of the knee, so make sure to get an evaluation by a physical therapist.
The pain around your kneecap can be placed in these broad categories: overuse or overloading the knee, weak hip and knee muscles, movement coordination deficits, and overly tight muscles.
Let’s see a couple examples to paint a picture of PFPS in action.
Ricky is a 24 year-old graduate student who spends 6 hours a day sitting for lectures, climbs stairs to class, and goes to the gym to squat his stress away. Ricky then goes home to eat a quick dinner, and sits on the couch to watch Netflix. He has repeated this lifestyle for 4 months and he now has intensifying pain in the front of his knee when sitting longer than 1 hour, climbing the stairs to class, and has pain even with squatting onto the toilet. Ricky went to his PT, who ran multiple tests on him and diagnosed him with PFPS.
Tammy is a 58 year-old architect who sits for several hours at a time and makes field visits to her construction sites. One weekend she went on a 3 hour-long hike with varying slopes. While going downhill on a trail, she noticed mild discomfort in the front of her left knee. By the time she finished the trail and reached her car, her left knee was terribly aching. There were no signs of redness, warmth, or swelling in her knee. She went to her PT, who ran multiple tests on her and diagnosed her with PFPS.
How will Ricky and Tammy improve their pain?
“It hurts if I do this” – “Then don’t do it”
Stop the painful activities to prevent further irritation, and allow the tissues to heal. Of course, we have to do what’s necessary for our daily responsibilities, like walking from point A to point B. Identify any activities throughout your day that would bring knee pain and if possible, find an alternative or stop completely. For Ricky, he can take the elevators and stop squatting; Tammy can temporarily stop hiking. The idea isn’t to remain sedentary, but to cut down the non-essential activities.
Flexibility is an important aspect in improving pain around your kneecap. We’re not necessarily talking about being able to perform the splits. For example, excessive tightness in your quadriceps, hamstrings, calves, or TFL (one of the muscles that are truly behind IT band discomfort – google it!) can lead to pain and discomfort in your knee. Imagine putting on an extremely small and tight T-shirt, and lifting a case of water to the top shelf. Can one do it? Sure. However, the freedom to move your arms is considerably restricted, and you’re forced to strain to get the job done, or until your muscles tear and scream mercy. The human body is incredibly resilient, which is why we can get by with overly tight muscles. In Ricky’s case, he managed 4 months of living with incredibly tight quadriceps from all the sitting, stair climbing, and squatting until his knee reached a substantial injury.
Building strength and improving mechanics
People with PFPS have been found to have weak hip strength and knee strength. Creating a plan for strengthening your glutes, hamstrings, and quadriceps through resistance exercises is crucial. If your knee pain is recent, you’ll want to focus on strengthening your glutes while you allow your knee to essentially cool down from the pain/irritation. This means exercising on the ground or anywhere you can lay down so that your knee isn’t burdened by your body weight. As the knee’s baseline pain lowers, you want to challenge your hip and knee with lightweight exercises and progress to heavier resistance. Maintaining proper squatting and lifting techniques, and watching for correct form during exercise, is an important principle to adopt as you recover because you can carry this into establishing lasting gains in the future. So for Ricky and Tammy, although their lifestyles are quite different their road to recovery is very similar.
What if I just don’t do anything?
Patellofemoral Pain Syndrome can be chronic if not addressed properly, meaning you can fall into a cycle where your knee feels better with rest but flares up again from repeated activity. If you have been experiencing pain in the front of your knee, or around your kneecap, talk to your doctor and get an appointment with a physical therapist.
Willy, R. W., Hoglund, L. T., Barton, C. J., Bolgla, L. A., Scalzitti, D. A., Logerstedt, D. S., Lynch, A. D., Snyder-Mackler, L., & McDonough, C. M. (2019). Patellofemoral Pain. Journal of Orthopaedic & Sports Physical Therapy, 49(9). https://doi.org/10.2519/jospt.2019.0302
Author: Jay Yi, PTA
Jay Yi, PTA received his Bachelor degree in Criminology, Law and Society from the University of California, Irvine with an intent to pursue a career in law enforcement. Having an inclination towards stories of healing and recovery, he furthered his schooling at Stanbridge University where he received an Associate degree in Physical Therapy as a Physical Therapist Assistant. Jay has experience working with young and old in various settings including orthopedics, sports medicine, and in-patient skilled nursing facilities. As a Physical Therapist Assistant, he values tailoring each patient's rehabilitation strategy to achieve their goals and functional abilities, and inspiring ownership of their progress. His other passions include Star Wars, monster burritos, making music, and road tripping.
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