Sports Medicine: Patello-Femoral Syndrome Spells Knee Pain

This source of pain is known by a seemingly unending variety of names, “runners knee”, “bikers knee”, the tongue twisters patellofemoral syndrome and chondromalacia patella. Why should anyone care about a problem with such a confusing and complex sounding name? Anyone with knee pain should listen up – according to many leading sources and sports clinics Patello-Femoral Syndrome (“PFS”) is the most common sports overuse injury. Indeed, many sports medicine clinics report up to 25% of their patients have been diagnosed with PFS. Furthermore, a published survey of 1,500 Bay Area runners, over a 6 month period, recently revealed that a whopping 43%  had “down time because of knee injuries” many caused by PFS.

WHAT IS IT? This syndrome is caused by an irritation along the cartilage under surface of the patella (knee cap). With this condition the knee cap tends to override the outside of the knee joint. The resulting inflammation and roughening prevents the knee cap from gliding smoothly across the femur (thigh bone). The end result is pain and swelling of the knee with increased activity or overuse.

EARLY SYMPTOMS … Typically patients describe a vague pain “inside or around the knee cap.” Initially this vague pain will hurt only after a workout or sometimes at night. But as the overuse progresses, the pain begins to appear more often and earlier, perhaps during the workout. Frequently this type of knee pain is aggravated by simple activities such as stair climbing, sitting or kneeling. With advanced cases pain and swelling may prevent full knee extension making walking difficult. Pain in other locations, locking or giving way of the knee are not part of this syndrome and should be examined by a knee specialist. Certain sports have a tendency to cause this problem. Among them are running, basketball, soccer, and sometimes tennis. Certain conditions tend to make people prone to this type of overuse injuring including: over-pronation, weak hip strength, decreased hip range of motion, weak quadriceps (thigh muscles), especially the vastus medialis and previous injury or other muscular imbalances.

TREATMENT IS OFTEN CURATIVE… Fortunately knee pain stemming from PFS is quite curable, in spite of the multitude of causes. A full 85% of patients respond to hip, knee range of motion exercises and isometric exercises aimed at strengthening the quadriceps. Biomechanical stabilization of the lower extremity through the usage of either over-the-counter or true functional foot orthoses is helpful.

SELF CARE TIPS … Exercise caution when “self diagnosing” this condition. Again, extreme pain in the knee, locking catching, excessive swelling or prior trauma to the knee are give aways that this is not PFS. In those cases, have it checked out by your doctor.

Here are a list of self-care tips if you think you knee pain as a result of PFS:
1. Decrease your activity level to that which is tolerable and does not produce pain or substitute activities, i.e., swimming instead of running.
2. Take a good look at your shoes, they may need replacement.
3. Consider high-quality, over-the-counter shoe insoles.
4. Ice around the area of pain after your workout. About 20 minutes should be sufficient.
5. Barring allergies and/or a history of ulcers or other G.I. problems, aspirin or ibuprofen may help.
6. Strengthen the quadriceps muscle. Leg extensions with weights may actually aggravate the problem so isometric strengthening is needed. To do this, sit with the knee locked or slightly bent. With your heel on the floor, contract the thigh muscle fully to the count of five, then relax. Frequent repetition is needed, about two sets of twenty reps daily.

This is just a partial list. To fully recover, you may need guidance from your sports podiatrist or orthopedist who may recommend orthotics to control excessive lower extremity motion, a special knee brace to guide the knee cap or some form of physical therapy to speed recovery. Either way, once the underlying causes are determined and appropriate steps are taken, Patello-Femoral Syndrome should not keep you from enjoying your activity.

~ Dr. Jeffrey J Niccoli   Board-Certified, Alameda Family Podiatry Group  Serving Bay Area patients from San Francisco, Oakland, Fremont, and Alameda

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