Patellofemoral pain

Patellofemoral pain

Patellofemoral pain, also known as runner's knee, is a common knee condition characterized by pain and discomfort around the front of the knee, specifically where the kneecap (patella) articulates with the thigh bone (femur).

It often results from activities that involve repetitive knee motion, such as running, jumping, or squatting. Rest, physical therapy, and proper footwear are often recommended for treatment.

Causes of Patellofemoral Pain

Patellofemoral pain occurs when the patella (kneecap) and the femur (thigh bone) do not function smoothly together. Several factors contribute to this misalignment:

Overuse: Engaging in repetitive activities that involve bending the knee, such as running, jumping, squatting, or climbing stairs, can lead to overuse of the knee joint.

Muscle Weakness or Imbalance: Weakness or imbalance in the muscles surrounding the knee, particularly the quadriceps and hip muscles, can affect patellar tracking and cause pain.

Poor Biomechanics: Abnormal alignment of the knee joint, such as flat feet or excessive pronation, can alter the patella's position, leading to pain.

Trauma or Injury: Direct trauma to the kneecap or a sudden fall can result in patellofemoral pain.

Symptoms of Patellofemoral Pain

Recognizing the symptoms of patellofemoral pain is crucial for early intervention. Common signs include:

Anterior Knee Pain: Dull, aching pain in the front of the knee, especially during weight-bearing activities like walking, running, or climbing stairs.

Pain with Prolonged Sitting: Discomfort may worsen after sitting for extended periods, such as during a movie or desk work.

Crepitus: Some individuals may experience a cracking or popping sensation when bending or straightening the knee.

Swelling: Mild to moderate swelling around the kneecap may occur.

Instability: A feeling that the knee is giving way or buckling, especially during physical activities.

Diagnosis

Diagnosing patellofemoral pain typically involves a comprehensive evaluation by a healthcare professional. This may include:

Medical History: Discuss your symptoms, activity level, and any previous injuries or medical conditions.

Physical Examination: The healthcare provider will examine your knee, looking for signs of tenderness, swelling, and joint stability.

Imaging: X-rays or MRI scans may be ordered to rule out other underlying conditions or assess the alignment of the patella and femur.

Functional Assessment: Your gait and movement patterns may be assessed to identify any biomechanical issues contributing to the pain.

Physiotherapy plays a crucial role in the management of patellofemoral pain (PFP) by addressing the underlying causes and helping individuals regain strength, stability, and pain-free movement in their knees.

Here are key components of physiotherapy management for patellofemoral pain:

Comprehensive Assessment: The first step in physiotherapy for PFP is a thorough evaluation by a physical therapist to understand the specific factors contributing to your pain. This assessment typically includes a review of your medical history, a physical examination of your knee and lower limb, and an analysis of your movement patterns and biomechanics.

Pain and Inflammation Management: Initially, the focus may be on reducing pain and inflammation. This can include techniques like ice therapy, manual therapy, or modalities such as ultrasound to alleviate pain and swelling.

Education: Understanding the condition is crucial. Your physical therapist will educate you about the causes of PFP and discuss activities or movements that may exacerbate your pain. They will also explain the goals of treatment and provide guidance on self-management techniques.

Range of Motion Exercises: To maintain or improve knee mobility, gentle range of motion exercises may be prescribed. These exercises help prevent stiffness in the knee joint.

Strengthening Exercises: Strengthening the muscles around the knee, particularly the quadriceps, is a central component of PFP management. Specific exercises target muscle imbalances and help stabilize the patella. Common exercises include leg presses, step-ups, and squats.

Hip and Core Strengthening: Many individuals with PFP have weaknesses in their hip and core muscles. Addressing these weaknesses is essential for improving knee alignment and stability. Exercises like clamshells, bridges, and planks can help strengthen these areas.

Stretching and Flexibility Exercises: Tight muscles, such as the iliotibial band (ITB) or hamstring muscles, can contribute to PFP. Stretching exercises help alleviate tension and improve flexibility. Focus on stretching the quadriceps, hamstrings, ITB, and hip flexors.

Proprioceptive and Balance Training: Proprioception exercises help improve joint awareness and control. These exercises can include standing on one leg or using balance boards to enhance stability around the knee.

Biomechanical Corrections: Your physical therapist may assess your gait and running mechanics to identify any issues contributing to your PFP. They can provide guidance on proper footwear, orthotic inserts, and running technique modifications.

Activity Modification: In some cases, it may be necessary to modify or temporarily avoid activities that exacerbate PFP. Your physical therapist will help you identify which activities to modify and provide guidance on safe alternatives.

Progressive Loading: As your pain decreases and your strength improves, your physical therapist will gradually introduce more challenging exercises and activities to help you return to your normal level of function and activity.

Home Exercise Program: To complement in-clinic sessions, your physical therapist will provide you with a personalized home exercise program. Consistency with these exercises is crucial for long-term recovery.

Monitoring and Follow-Up: Regular follow-up appointments with your physical therapist will allow for ongoing assessment of your progress and adjustment of your treatment plan as needed.

Remember that the effectiveness of physiotherapy for patellofemoral pain depends on consistent effort and adherence to the prescribed exercises.

ASPIRE APPROACH TOWARD PATELLOFEMORAL PAIN

We work on the root cause of your problem by proper assessment and Diagnosis followed by symptomatic management, and strengthening exercises.

By Dr. Anamika Bhandari (Physiotherapist)