PFPS is known for a gradual onset of sharp achy pain just below the patella (Kneecap)at the front of the knee just below the femur. This pain is often exacerbated or made worse when those who suffer from it engage in prolonged load bearing activities such as running, walking up or down hills, make sudden lateral shifts in the transverse plane or engage in kneeling or squatting movements. Depending on the severity, swelling may or may not accompany the pain. 

The name “Patello-Femoral” is descriptive in that the pain resides at the junction of the patella and the femur (Stax, 2017). This is where the thigh and the knee meet. The pain is often a result of poor patellar tracking (WEISENFELD, 1981; Souza RB, 2009; S., 2011; Pappas E, 2012; Michael A. Clark, Scott C. Lucett, & Brian G. Sutton, 2014; American Council on Exercise, 2015; Lippert Lynn S. PT, 2017). The kneecap is a large sesamoid bone that is stabilized by the patellar ligament. As the knee extends and flexes the patella glides between the surfaces of the femur and tibia. If the patella tracks too far to the left or right, it may result in pain. If the patella tracks too closely to the femur it may cause pain. The etymology (Causes) for PFPS is widely debated and there is no definitively known and agreed cause to this syndrome to date (WEISENFELD, 1981; S., 2011; Michael A. Clark, Scott C. Lucett, & Brian G. Sutton, 2014; American Council on Exercise, 2015; DAVID Y. GAITONDE, ALEX ERICKSEN, & and RACHEL C. ROBBINS, 2019).

There is however agreement among the known associations with PFPS that may contribute to it or that the condition may be attributed to. These causes include biomechanical causes such as Pes Planus and Pes Cavus (Flat feet and High Arches), Knee Valgus and Varus (Knock Knees and Bowed Legs). There may also be neuromuscular imbalances such as synergistic dominance of the adductors of the thigh, weakness of the Vastus Lateralis and Vastus Medialis, and shortening of the Gastrocnemius, Soleus and Hamstrings Complex. Furthermore, there has been a correlation with those who have weak hip extensors and abductors and prevalence with PFPS (Stefanyshyn DJ, 2006; Van Tiggelen D, 2009; S., 2011; Michael A. Clark, Scott C. Lucett, & Brian G. Sutton, 2014; American Council on Exercise, 2015). Hip extensor weakness such as the gluteals; Maximus and Medius contribute to many lower body static posture dysfunctions, muscle imbalances, and movement dysfunctions (S., 2011; WEISENFELD, 1981; Michael A. Clark, Scott C. Lucett, & Brian G. Sutton, 2014; American Council on Exercise, 2015; Lippert Lynn S. PT, 2017). Lastly, improper movement mechanics may play a role in fostering biomechanical and neuromuscular dysfunctions that contribute to PFPS (WEISENFELD, 1981; Stefanyshyn DJ, 2006; Souza RB, 2009; S., 2011; Michael A. Clark, Scott C. Lucett, & Brian G. Sutton, 2014; American Council on Exercise, 2015; Lippert Lynn S. PT, 2017; Pappas E, 2012). 

Without a thorough static, movement, and gait assessment it is difficult to identify exactly where to start on any corrective exercise programming. However, based on the data across many cases we can give some comfort in prescribing a general strategy for bulletproofing oneself against PFPS. This includes implementing the I-LAST protocol. When dealing with correcting neuromuscular imbalances corrective exercise specialists, medical exercise specialists, and physical therapists approach the issue using inhibition, lengthening, activation, strengthening, and integration of the effected muscles. I like to use the acronym I-LAST. I-LAST stands for Inhibit, Lengthen, Activate, Strengthen, Throw it all together (Integrate).

Inhibit –Trigger point, Self- Myofascial Release techniques are used to prevent overactive muscles form becoming dominant

Lengthen – Properly stretching overactive and shortened muscles AFTER inhibition techniques are performed can help to restore muscles to normal resting length

Activate –A variety of isometric, callisthenic, and band resisted exercises can be used to activate inactive, underused, and lengthened muscles

Strengthen – Once muscles have become activated and the neurons are firing correctly, they can be strengthened using progressive resistance.

Throw it all together (Integrate) – Integration of an injured muscle or other injury first includes normal activities of daily living, and then can be specialized to sport and occupation specific activities. Integration should be progressive, and one should challenge themselves but take caution in not pushing too hard too quickly.

Knee pain can be painful and that is due to the inflammation that occurs most likely from improper patellar tracking. For this it is always recommended to practice RICE/ PRICE Protocol. 

Protect – Protecting the injury with appropriate bracing may be necessary for extreme circumstances. Although it is recommended that you seek physician guidance when it comes to bracing, Bracing does provide relief in many cases, and this is primarily because of the compression associated with bracing and the additional support that braces give. There are a variety of over-the-counter braces that one can use to help protect injuries. 

Rest – Stop doing whatever it was that causes you pain. Rest the injury do not do anything to aggravate it. 

Ice – Apply ice to the site of injury. Ice can help to comfort the hot sensation caused by increased blood flow to the area and to reduce inflammation, which will help to reduce swelling and bruising

Compression – Compression can help to ease the pain associated with swelling and aid in the blood flow to the affected area. It can also help to control the swelling. Compression can be achieved by properly bandaging and with the use of over-the-counter splints and braces which have built in mechanisms of compression

Elevate – Elevation is important in the reduction of pain and swelling in that it prevents blood from pooling in the affected area thus preventing additional swelling and reducing pain and throbbing. The limb / injury should ideally be elevated above the heart to maximize the hydrostatic effect.

This article discusses the condition of Patellofemoral Pain Syndrome, how to recognize it, correct it and deal with pain. It is important to remember that the best intervention for PFPS is early intervention. If you are experiencing frequent and recurrent knee pain that is aggravated by activities of daily living or exercise, see your physician. He or she will best be able to assist you and guide you in diagnosis and treatment of the injury. In fact, many physicians believe in the effectiveness of corrective and medical exercise protocols. It is the very reason that the American College of Sports Medicine (ACSM) has developed their Exercise Is Medicine Credential. If your physician diagnoses you with PFPS you may ask to be referred to a specialist in corrective, medical or therapeutic exercise to help you. 

       References

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