Patellofemoral (Anterior Knee) Pain Explained

Anterior knee pain or Patellofemoral pain syndrome (PFPS) is characterised by knee pain behind the patella or kneecap.  It is of non-traumatic cause but may occur after an injury and can affect people’s daily lives quite significantly.  Some common complaints include pain going up and more likely down stairs, pain when sitting with a bent knee too long (such as in the car or movies) and pain with increased exercise especially running activities.  It can affect both men and women although is most common in young women.  It can be related to activities such as running due to a lack of pelvic stability and knee control and is made worse by overtraining.

With PFPS there is normally a maltracking patella and there may be an increased patella height. There is normally a muscle imbalance with a weakness in the inside quadricep muscle called the VMO and poor pelvic stability and knee control with single leg squat.  VMO weakness can occur due to disuse such as after injury, pain inhibition and a poor patella position due to a lateral pull with tightness in the outside retinacular and ligamentous structures.

There is normally a weakness in the deep pelvic stabilisers which causes overactivity in the outer muscle group around the hip and pelvis.  This will lead to a tightness in the band on the outside of the leg (ITB) which has attachments to the patella and can pull the patella laterally or cause a lateral tilt, both affecting the alignment.

This population of people may also show some overpronation or increased rolling of the foot which will further disrupt the tracking of the patella.  An orthotic may be required to correct this biomechanical dysfunction.

In physiotherapy it is important to address all of the underlying causative factors.  This requires a biomechanical assessment to look at patella tracking, muscle imbalance and weakness, foot posture and function, footwear, training regimes and exercise advice.  Without all of these factors assessed and then treated by soft tissue massage, mobilisation, stretches and strengthening work +/- prescription of orthotics it is common to find that the condition of PFPS can reoccur.

By Melanie Roberts

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