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Knee pain is a common complaint for many athletes and non-athletes alike. Patellofemoral Pain Syndrome (PFPS) is one of the most common injuries of the lower extremity; this injury is characterized as pain under the kneecap or around the kneecap. The patellofemoral joint is where the knee cap (the patella) articulates with the thigh bone (the femur).
What Causes Patellofemoral Pain?
In healthy knees, when we bend and straighten the knee, the kneecap glides up and down in a groove on the thigh bone (the Femoral groove). Pain often occurs if the knee cap begins to track laterally; this poor tracking or misalignment most commonly occurs as a result muscle imbalances or poor mechanics. The most common reasons for muscle imbalance/poor mechanics include disuse or deconditioning and overloading (ie. increasing activity volume too quickly)[Physioworks,2015].
Stretch what is tight, Strengthen what is weak
There is strong evidence that PFPS responds well to exercise therapy[Clijsen R, et.al 2014]. In my clinical practice, I often find it is very helpful to stretch what is tight; in the case of PFPS this often includes stretching the Quadriceps, the Hamstrings, and the Iliotibial Band (IT Band). The other component that has been shown to reduce pain with PFPS is to strengthen the following muscle groups: the hip abductors (buttock muscles), and the medial quadriceps (thigh muscles close to midline). Here are some examples of exercises I commonly prescribe for PFPS:
Quadriceps Stretch: In standing, while maintaining a straight back, bend one knee and hold the ankle with the hand on the same side. Keep thighs together so that the knee that you are stretching is pointing down towards the floor. Pull ankle towards the buttock to increase the intensity of the stretch as needed.
Hamstrings Stretch: In sitting place one leg out with a straight knee, bend the other knee and place the foot of this leg against the inner thigh of the straight leg. Sit up tall through the trunk and lean forward from the hips. This stretch should be felt along the back of the thigh.
Ilitotibial Band Stretch: In standing cross the foot of the leg you are stretching behind the other foot (feet should be approximately 30-50 cm apart), lean the same hip out to the side and lift the same arm up and over the opposite side. This stretch should be felt in the upper aspect of the outer hip.
Each of the above stretches can be held for 10-30 seconds. Repeat 3 times. Daily. Do not hold painful positions while stretching; if painful adjust positioning.
Hip Abductors: Lay on side with bent knees stacked. Straighten out top leg and while maintaining a straight line with your trunk, lift the top leg up 10-20cm. Lower leg back down to meet the bottom leg. Can be repeated on both sides.
Medial Quadriceps: Straight leg raise-laying on back with one leg straight and one leg bent, slowly lift straight leg up 10cm, slowly return leg back down. Repeat on both legs.
Strength exercises can be completed up to 5x/week. 2 sets of 10 repetitions. These exercises should not be painful.
[Joe] was always clear about the intention of the treatment, was very helpful with information around the injuries... I found him knowledgeable, approachable and always took the time needed for each appointment.
–Trish P, Langford