Patellofamoral Syndrome

Patellofemoral pain syndrome, also called "runner's knee", is a painful condition around your kneecap, patella. The pain mostly affects sports persons who are involved in stressful activities such as running and jumping.

The knee pain is worsened by running, walking up or down stairs, sitting for long periods, or squatting. Rest and ice can alleviate pain to some extent but in some cases, you may require physical therapy sessions.

The main symptom of patellofemoral pain syndrome is a dull pain in the front part of your knee, which is exacerbated by:

• Stepping up or down stairs
• Kneeling or squatting
• Sitting in a position that involves bending your knee for a long time

When to see your doctor?

Visit your doctor if the pain in your knee persists for longer.

The exact cause of patellofemoral pain syndrome has not been understood yet. However, the pain seems to be associated with:

• Excessive stress on your knee: Repetitive stress on your knee caused by activities like running or jumping can irritate the area under the kneecap.
• Muscle imbalances or weaknesses: When you have weak muscles around your hip and knee, it cannot hold your knee cap in its proper position. This can lead to imbalance and increased stress on your knee. Patellofemoral pain due to inward curving of the knee is common in people who don’t squat properly.
• Knee Trauma: Any trauma that affects your kneecap, such as a dislocation or fracture, can cause patellofemoral pain syndrome.
• Surgery: Surgery that uses your patellar tendon as a graft to repair the anterior cruciate ligament can also cause patellofemoral pain.

Diagnosis of patellofemoral pain syndrome will be made by your rheumatologist or sports medicine specialist.

The diagnosis begins with a question-answer session where you will be asked your history of knee problems. Your doctor can also physically examine your knee and its movements to eliminate other similar conditions.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms. Write down your key medical information. Bring your X-ray reports, if any.  Write down the names of all your medications, vitamins or supplements.

Ask a friend or a family member to accompany you during the visit. Make a list of the questions to ask your doctor. Some typical questions can be:

• What could be the most probable cause of my knee pain?
• What are the tests needed?
• How long will my condition last?
• Do you recommend any best course of action?
• Can you suggest me alternatives to the primary approach, if any?
• Is it necessary to limit my activities?
• Will you refer me to a specialist?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

• How is your knee pain?
• Can you show me where it hurts?
• Is your pain aggravated by running or jumping?
• What’s your level of athletic activity?
• Did the home treatments help you, if any?

For further investigations, your doctor may recommend imaging tests such as:

• X-rays: X-rays are used to visualize bone. It is less effective for detecting abnormalities in the soft tissues.
• CT scan: It uses a number of X-ray images to produce a detailed images of your bone and soft tissues.
• MRI: It uses radio waves and a strong magnetic field to produce detailed images of bones and soft tissues, such as the knee ligaments and cartilage.

Treatment for patellofemoral pain syndrome involves simple measures such as rest and avoiding or minimizing aggravating factors such as:

• climbing stairs,
• kneeling or squatting.

Some other treatment options include:

• Medications: Non-prescription pain killers such as acetaminophen, ibuprofen or naproxen may help reduce pain.
• Therapy: You may need to see a registered physical therapist. S/he might suggest:
  • Rehabilitation exercises: You can learn exercises to strengthen your quadriceps, hamstrings and the muscles around your hips, especially hip abductors. These exercises help you to avoid inward movement of the knee during a squat.
  • Supportive braces: You may also use knee braces or arch supports to alleviate pain.
  • Taping: You can learn to properly tape your knee, to improve pain and your ability to exercise.
  • Ice: Applying ice on your affected knee after exercise can reduce pain.
  • Low-impact sports such as bicycling and swimming or water running are knee-friendly. Give them a try while you are recovering.
• Surgical and other procedures: When your pain does not improve with nonsurgical treatments, your doctor might recommend:
  • Arthroscopy: This minimally invasive procedure involves inserting a thin, lighted camera-containing tube (arthroscope) into your knee through a tiny incision. Portions of damaged cartilage are then removed by passing instruments through the tube.
  • Realignment: It is a more complicated surgical option reserved for more-severe cases which involves knee surgery to realign the angle of the kneecap or lower pressure on the cartilage.

Following strategies can help prevent patellofemoral pain syndrome:

• Strengthen your muscles that support your knees and keep them in balance during stress. Do exercises that keep your quadriceps and hip abductor muscles strong but AVOID deep squatting.
• Learn proper techniques for jumping, running and pivoting. Consult your doctor or physical therapist to learn exercise techniques that prevent inward movement of your knee while squatting, landing from a jump or stepping down from a step.
• Shed some pounds, if necessary, to put a lighter load on your knees.
• Set aside some minutes for warm up before running or other high impact exercises.
• Be flexible: Do some stretching exercises before and after your main exercise regimen.
• Do not jump to a high intensity exercise: Take your time and do your exercises in absolutely proper form before you think of upgrading to a higher intensity level.
• Right fit of shoes is the key: Shoes that fit right absorb shock properly when you are landing from a jump or performing a jump squat.