What is it?
This clinical conundrum is often aptly named “The Black Hole of Orthopaedics”, implying that no single explanation or therapeutic approach has yet fully clarified this problem. The primary factor differentiating this clinical problem from other knee conditions is its inherent subjectivity. Anterior knee pain, or patellofemoral pain, is pain in the front of the knee which is often made worse by sitting for prolonged periods, stair climbing or any activity which involves bending the knee. It is often aggravated by sport.
The origin of patellofemoral pain can be directly traced to supraphysiological mechanical loading and mechanical or chemical irritation of nerve endings. Even activities of daily living can become supraphysiologic. This syndrome is caused by an irritation or damage to the undersurface of the patella, or patellofemoral articulating surfaces, often inappropriately called chondromalacia patella. “Runner’s knee” is a popular description, but it is not a good term to use, because there are at least a half dozen other conditions that could be meant by it, especially iliotibial band syndrome. And of course it excludes other people who get the condition — all those people with cyclist’s knees and hiker’s knees, for instance!
Studies have shown that the so-called patellofemoral pain syndrome comprises up to 50% overuse injuries. Almost 40% of pro cyclists will get anterior knee pain in any given year, but runners are by far the most numerous victims, and often the most frustrated ones.
Nonsurgical management continues to be the mainstay of treatment for Patellofemoral pain syndrome. Historically this has involved strengthening the quadriceps muscle, in particular the vastus medialis oblique muscle.
Do’s & Don’ts:
You should try to find good professional help, but you’ll need to be informed when you do it or you can easily waste a lot of time and money on dubious therapies.
“Stay active” is one of the most common recommendations — but it may be the worst therapy of all for patellofemoral pain. It’s just knee jerk advice, given by professionals unfamiliar with the nature of PFPS. Treating PFPS like arthritis is a basic misunderstanding of the condition. Family doctors usually do this, but they are generally poorly informed about PFPS. Hip strengthening is a new treatment — almost fashionable — but it is far from proven and has been over-hyped since about 2005.
Jesse Elliott, DPT, Licensed Doctor of Physical Therapy with Siskiyou PT
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