"It Feels Like The Pain Is Under My Kneecap!"

March 5, 2010 - PRLog -- "It Feels Like The Pain Is Under My Kneecap!"
Written by Dr. Ian MacIntyre, BSc, DC, FCCSS(C) - Affinity Health Clinic - Toronto
Patellofemoral pain syndrome (PFPS) is a term used to describe pain originating from the region of the patella (kneecap) and femur (thigh bone). It is an extremely common complaint among active patients. And, it is likely the most common complaint of athletes, and nonathletes, presenting to the practitioners at Affinity with a primary complaint of knee pain.
Patients with PFPS describe pain primarily in the front of their knees – on one or both sides. Patients typically describe pain with stair climbing, especially when going down the stairs. They frequently describe pain with prolonged sitting (like watching a movie). It is generally an aching pain, but can become sharp in nature and even be associated with a burning sensation. On occasion, patients may describe a sense that their knee may “give out” on them. This occurs particularly when going down the stairs. The onset of symptoms is frequently associated with the start of a new activity or increase in level of intensity/frequency of an activity.
There have been many theories in the literature over the years regarding the etiology of the condition. These theories range from maltracking of the knee cap on the femur to muscular dysfunction around the knee. The cause of this pain is not clearly understood and researchers can not agree on one particular risk factor leading to the development of PFPS. The term “syndrome” is very fitting because it is most likely multifactorial in nature. The good news is that physical rehabilitation and therapy have been highly effective in the treatment of the dysfunction, allowing patients to continue their regular training regimens.
Recently, studies have recognized that factors above and below the knee influence its’ mechanics. The knee joints, and mechanical changes at the knee due to dysfunction above or below the knee, may lead to the development of PFPS. This has been especially evident for patients who spend the majority of their time weight bearing on one foot. While running, the centre of our mass (midline of the body) is constantly inside the base of support (the foot). This means the muscles on the outside of the hip (abductors) must constantly work to keep the body from tipping over (hip jutting out). This imposes a huge stress on the abductors, which can cause fatigue and overuse in the abductor muscle groups.
When the abductor muscles of the hip become fatigued the pelvis and hip drop to the side of the non-weight bearing leg. You can recognize this when you feel your belt line is no longer parallel with the ground. This shift causes the weight bearing knee to excessively angle inward. This increased angle at the knee joint allows the kneecap to be pulled up and to the outside when the quadriceps muscle contracts to absorb our body weight. A functional malalignment develops and causes increased pressure between the femur and kneecap. Coupled with the repetitive impact of running, PFPS can develop. Fortunately, strengthening the muscles responsible for hip/pelvic stability has been found to alleviate the symptoms associated with PFPS and correct this malalignment of the pelvis, knee and foot.    
As with most rehabilitation programs a one-size-fits-all approach does not exist. The strengthening program must be tailored to the patient’s individual dysfunctions. Dr. MacIntyre has found that most patients who have been given a carefully designed exercise program to address their unique weakness need very little in hands on treatment and, if the program is used on a regular basis throughout the training season, they rarely return due to a recurrence of the knee pain.

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