Patella Femoral Joint Syndrome is an overuse or overloading injury and one of the most common presentation of knee pain. Anatomically, it is caused when the patella is malaligned within the femoral groove which creates increased force and irritation to the knee joint. It is most commonly due to a lateral glide or tilt of the patella and this repeated trauma results in pain as the joint surfaces are unevenly loaded.
Pain is usually of gradual onset and is felt at the front or inside of the knee. It is aggravated after activities that increase the compressive forces through the knee joint eg. using stairs, squatting, kneeling, prolonged sitting.
It can also come on after a change in activity such as starting something new, changing surfaces, changing footwear or increasing training load. All of these may overload the knee and result in onset of pain.
It occurs due to a combination of factors relating to muscle imbalance, muscle weakness, tight soft tissues, foot biomechanics and anatomical variations. Assessing these individually and addressing them is essential to overcoming the injury.
Contributing Factors Muscle Imbalance: weakness of the medial quadriceps compared to the outside portion causes a lateral tilt or translation of the patella.
Weakness of hip muscles, mainly the gluteals, increases adduction and internal rotation of the knee. This then increases force through the medial aspect of the knee. It also increases tension through the Iliotibial band (ITB) and compensatory foot pronation causing patella malalignment.
Tightness lateral structures: As mentioned above, a long fibrous band called the ITB can have increased tension. This band attaches onto the lateral aspect of the patella and along with the lateral quads and tensor fascia lata (another small muscle) can exert a lateral pull on the patella causing a glide or tilt to one side.
Foot Biomechanics: Increased pronation of the foot (rolling in) causes increased tibial rotation (shin bone rotating in the knee joint) and can change the tracking of the patella in the femoral groove (space where the knee cap sits in the knee joint), resulting in pain.
Anatomical variations: width of the pelvis (particularly in females), knee hyperextension, flat feet and “knocked knees” change biomechanics and load through the knee and can contribute to PFPS.
Treatment One of our physiotherapists in Kew or physiotherapists in Oakleigh, will assess for the contributing factors and provide you with an individualised management program. This may consist of rest or modifying activity, strength exercises, self massage or using a foam roller, changing your activity frequency or load, changing your footwear, or taping and orthotics in cases where pain is more severe.
It is pivotal that you consult with your local healthcare professional if you injure your knee and have concerns over meniscus problems. If you have any further questions or require treatment on your knee, please call us on (03) 9568 1011/ (03) 9853 7836 or visit www.alignhc.com.au and make an appointment to see one of our friendly staff.
