The patellofemoral pain syndrome is a very common knee problem, especially among athletes. Also women and teenagers have a higher risk in developing patella femoral pain syndrome.
Fortunately it’s very well treatable with the right exercises. You should be able to run again in a matter of weeks.
But first you’ll have to know that it’s often caused by a combination of several things. This is why the treatment consist of so many exercises.
In this article we are going to cover everything there is to know about the cause of the patellofemoral pain syndrome and how you can effectively treat it yourself. We’ll also explain to you the difference between the patellofemoral pain syndrome, Chondromalacia patellae and a runners knee.
This is everything you’re going to learn:
- What is the patellofemoral pain syndrome?
- What are the symptoms of the patellofemoral pain syndrome?
- What is the difference between the patellofemoral pain syndrome and Chondromalacia patella?
- What is the cause of the patellofemoral pain syndrome?
- What does the patellofemoral pain syndrome treatment looks like?
What is the patellofemoral pain syndrome?
The patellofemoral pain syndrome is caused by dysfunction of the patellar tracking in your knee.
Your patella or knee cap is located inside your quadriceps tendon. This is the connection between your quadriceps and your tibia or lower leg. The knee cap sits in a groove at the end of the thighbone. A layer of cartilage lines the underside of the knee cap to smoothen the gliding of the knee cap.
When you bend your knee your knee cap shifts down your knee and a little bit to the outer of lateral side of your knee. When you extend your knee your knee cap shifts up and a little to the inside or medial side of your knee. This is called normal patellar tracking.
With the patellofemoral pain syndrome the patellar tracking is disturbed. This causes the surrounding structures to become overused. Overusing of structures is the main cause of your pain. This is why your pain is diffuse and difficult to put your finger on.
If you suffer from the patellofemoral pain syndrome, you can notice this in your knees. Sit on a chair with your knees bend. Now you can see that the knee cap of your painful knee is more central orientated compared to your injured knee.
We will discuss the different causes and patellofemoral pain syndrome treatment later on.
What are the symptoms of the patellofemoral pain syndrome?
The main characteristic of the patellofemoral pain syndrome is pain in different parts of the knee. Usually you feel pain at the lateral side or around your kneecap. Sometimes there may also be pain present under your knee cap.
Pain often occurs during:
- Sitting for a long period of time with your knee’s flexed.
- During squatting
- When you kneel down
These symptoms are caused because of the problems in the patellar tracking. This causes stress on the surrounding tissue, especially in the activities named above.
What is the difference between the patellofemoral pain syndrome and Chondromalacia patella?
We often see that the terms patellofemoral pain syndrome, chondromalacia patella and runners knee are mixed together. Apparently it’s not very clear what the difference between these conditions is.
That’s why we will explain the difference to you:
The patellofemoral pain syndrome
As stated before the patellofemoral pain syndrome is caused by a dysfunction in the patellar tracking causing overuse of the surrounding tissue.
A runners knee is also known as the Iliotibial band syndrome. The pain is located on the lateral or outer side of your knee. It is caused because of tightness of the iliotibial band. The iliotibial band is a thick band of fascia on the lateral aspect of the knee, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee.
Due to the tightness your iliotibial band rubs over your lateral femoral epicondyle. Because of this constant rubbing your iliotibial band get irritated, causing pain.
Chondromalacia patella is caused by the disappearing of the cartilage on the back of the knee cap. Because of this friction between you knee cap and thighbone may increase. This will affect the patellar tracking. This means that chondromalacia patella is actually one of the causes of the patellofemoral pain syndrome.
What is the cause of the patellofemoral pain syndrome?
There are several different causes for the patellofemoral pain syndrome. One of them is chondromalacia patella as stated above.
There are 6 contributing factors that may increase the risk for developing the patellofemoral pain syndrome. However not everyone has all 6 of them.
These 5 are:
- Weak or tight quadriceps
- Overuse of the knee
- flat feet
- Weak or tight hip muscles
Research shows that hypermobility is a risk factor for the development of the patellofemoral pain syndrome.
Hypermobility is very common especially in woman and teenagers. Hypermobility means that your joints are more flexible than on average. Because of this hypermobility it’s easier to hyperextend your knees.
When you are standing gravity tries to pull you forward. This causes your knees to hyperextend when you stand if that’s possible.
Hyperextending your knees however removes the tension on your quadriceps. They don’t have to do anything because gravity will keep you in this position. This reduces the strength of your quadriceps because they’re not trained as much as they should be.
Quadriceps strength however is very important in proper patellar tracking. Therefore hypermobility is a risk factor in developing patellofemoral pain syndrome.
In order to counter these hypermobility problem you have to adjust your posture. When you bend your knees slightly during standing, you’ll have to tens your quadriceps in order to maintain this position. This will help you to train and use your quadriceps properly.
On the other hand, when the mobility of your patella is decreased this can also cause problems for the patella tracking.
It places the patella closer to your thigh bone. This means that when you try to bend your knee, it crapes along your thigh bone. This usually causes pain.
When you have flat feet because of fallen arches or being overweight the angle of your ankle and knee also changes. Due to this change in the arch, the position of your lower leg also changes. This is called x-legs or knock knees.
In the picture you can see what knocked knees look like. Because of the different angle of your knee, also your patellar tracking is changed. It can decrease the mobility of your patella which might cause the patellofemoral pain syndrome.
Luckily not every person with knocked knees will get patellofemoral pain syndrome. But it is found that people with knocked knees tend to get knee pain faster.
Weak or tight quadriceps
As stated above weak quadriceps muscles are a risk factor in developing patellofemoral pain syndrome. Research supports this statement.
The tendons of your quadriceps muscles cross your patella and attach to the tuberosity of the tibia. When your quadriceps are too tight these tendons apply more pressure on your knee cap. This pressure prevents him from gliding properly.
Secondly your quadriceps normally take some pressure of your knees. Weak quadriceps result in more pressure on your knee. This extra pressure is one of the causes of the patellofemoral pain syndrome.
Overuse of the knee
Overuse of the knee can affect the knee in several ways. One of these ways is that because of the overuse your joint capsule can become damaged.
Damaged joint capsule tends to tens up. Because this joint capsule covers your patella this will force your patella closer to your knee. This will make gliding of your patella more difficult because there is more friction.
Ultimately this will result in patellofemoral pain syndrome.
Weak or tight hip muscles.
The final possible cause of developing the patellofemoral pain syndrome are weak or tight hip muscles.
The function of your hip muscles is to keep your hip horizontally when you lift up your leg. Due to weakness of your hip muscles your hip lowers when you lift up your leg. This is called the trendelenburg sign.
In the picture you can see that with a trendelenburg sign the angle of your knee changes, limiting the mobility of your knee cap.
Also your hip muscles and glutes do the majority of work when walking or running. When your glutes are weak this work needs to be overtaken by your quadriceps. This can cause overuse of your quadriceps resulting in knee pain.
What does the patellofemoral pain syndrome treatment looks like?
Rest alone is not going to help to recover from the patellofemoral pain syndrome. This is because rest is not going to increase the mobility of your patella, which is crucial for your recovery. Also we have to tackle the 5 possible causes for the patellofemoral pain syndrome.
Therefore we will discuss al 5 causes and how we will treat them with exercises. We will use 5 exercises for this.
Patellofemoral pain syndrome exercise 1: Increase the mobility of the patella
The purpose of this first exercise is to increase the mobility of your patella. Only when the mobility of your patella is restored, you’re able to recover from your patellofemoral pain syndrome. Therefore perform this exercise as often as possible.
Remember only to do this exercise when the mobility of your patella is decreased. When you have a hypermobile patella, you should not do this exercise because it will only get worse.
Perform the exercise like this:
- Sit down with you leg straight
- Place your thumb on the inside of your patella
- Now push your patella to the outher side
- Hold this for 10 second
- Repeat this 10 times.
Try to perform this exercise several times a day. Whitin a few days you should notice that the mobility of your knee cap increases.
This will reduce the pain of your patellofemoral pain syndrome.
Patellofemoral pain syndrome exercise 2: tackling hypermobility
Hypermobility is not something we can cure. However as we mention before, the problem with hypermobility is poor posture. So in order to tackle the problems caused by hypermobility you have to train your posture so the pressure on your knee degreases.
With the following patella femoral pain syndrome exercise you can train your posture.
For good posture you need to pay attention on the following things when standing:
- Place your bodyweight on the back of your feet
- Slightly bend your knees
- Pull your stomach in
- Stretch up your chest
- Lift up your head
In the next video you can see how to correct yourself and what good posture looks like.
At first, it will feel weird because your body tells you it’s wrong. It will take 2 weeks of good practice to make it feel normal.
You can do this by constantly correcting yourself on your posture. After a while you will feel that you stand correctly without thinking about it.
It can also be tiring at first but this will get over soon as well.
Patellofemoral pain syndrome exercise 3: Tackling Weak or tight quadriceps
The purpose of the second exercise is to increase the strength of your quadriceps. We will use the active straight leg raise for this. With the active straight leg raise you can train your quadriceps without bending your knee or putting a lot of pressure on your knee. Therefore this exercise is better at this point then the squat or legpress.
Perform the exercise like this:
- Lay down on your back with your legs completely stetched
- Pull your toes towards you
- Now lift up your leg straight up and let it come down again
- Repeat this 10 times
- If this is to easy you can do it 15 or even 20 times
- Repeat this 3 times
You can see how to perform the exercise here below on the video.
Perform this exercise 2 times a day. You will notice that you healthy leg will go much easier then your painful leg.
As the exercise becomes easier you will also feel less pain in your knee.
You can also increase the difficutly of the exercise by adding some weight.
You can do this by adding these
Patellofemoral pain syndrome exercise 4: tackling flat feet
There are actually 2 ways to correct flat feet.
The first option is to take insoles. Insoles in your shoes will lift the arch of your mid foot a little bit, giving it a better position.
The second option is training. When you’ll train your feet, your feet muscles will get stronger. When they become stronger, it’s easier for them to maintain the natural arch of your feet. Flat feet is usually caused by limited strength of your feet muscles.
The following patellofemoral pain syndrome exercise will train your feet muscles to overcome flat feet. Perform this exercise twice a day, every day.
Patellofemoral pain syndrome exercise 5: Weak or tight hip muscles
For this we will give you 2 exercises. One to train your hip muscles and the other one to stretch your hip muscles.
The purpose of this exercise is to increase the strength or your hip muscles.
Perform the exercise like this:
- Lay down on your healthy side
- Extend your leg and pull your toes towards you
- Lift up your leg with your knee extended
- Make sure you keep it in line with the rest of your body
On the video below you can see how to perform the exercise correctly.
Perform this exercise twice a day every day. Start with 3 sets of 10 repetitions and slowly increase it to 3 sets of 20 repetitions. With this exercise you can train your hip muscles without overusing your knee.
When the exercise becomes too easy this way you can also add some weight through these ankle weights.
By adding these weights you can increase the strength of your piriformis muscle even more, giving you even better results.
You can choose between different weights based on your strength.
You can also use these weights for various other exercises.
And later when even this becomes too easy you can start doing steps at home.
When you do steps on a daily basis you will not only increase the strength of your piriformis muscle, but also of all the other muscles in your leg.
Also, you will increase your stamina and the cartilage in your knee reducing problems of osteoarthritis.
Overuse of the knee
With the exercises described above we tackled most causes for overuse of the knee. Because your quadriceps are stronger they take pressure of your knee. The last cause for overuse of the knee is often overweight.
If you are overweight and have knee problems, you might benefit the most of losing weight. Your bodyweight puts a lot of pressure on your knees and is one of the biggest reasons people develop knee problems.
Knee pain caused by the patellofemoral pain syndrome is very well treatable within a few weeks. Perform these exercises regularly and you’ll see your knee problem disappear.
When you have any question feel free to e-mail me at [email protected] and I will update this page.
When you found this page helpful feel free to share it with your frends and other patients with patellofemoral pain syndrome.