Patellofemoral Pain Syndrome the result of abnormal alignment (tracking) of the knee cap (patella).  The kneecap normally goes up and down in it's groove as the knee bends and straightens.  When the patella is misaligned, it will rub against the side of the groove and can cause cartilage wear and tear.  These physical and biomechanical changes in the joint often result in pain behind the knee cap, known as retropatellar pain. 

Factors that affect patellar alignment

1.  Bony-
  • High or Low Riding Patella (Patella alta or Patella Baja)
  • Knock-kneed (Genu valgus) or bow-legged (Genu varum)
  • Hyperextension (Recurvatum) of the knee

2.  Soft Tissue Tightness

Quadriceps Muscle, Hamstring Muscles, structures on outside of knee.  When one or all of these muscles become tight, excessive stress placed on the patella can cause misalignment.

3.   Muscle Imbalance- Weakness of the VMO muscle (the only dynamic medial stabilizer of the knee) allows the patella to track too far to the outside and causes degenerative changes in this area.  Pelvic muscle imbalances and deviations in an individual's gait pattern also contribute to patellofemoral pain syndrome. 

Signs & Symptoms
  1. Anterior (front) Knee Pain that usually occurs after prolonged sitting or activity.
  2. Increase or Decrease in pain intensity when descending steps or hills.
  3. Crepitus- creaking in the joint or "rice krispies" in the joint while bending and straightening the knee.
  4. Buckling of the knee.
  5. Locking or catching of the knee.

Treatment

Usually, physical therapy is prescribed and should include stretching, strengthening, and patient education of your injury. 

Areas to be Stretched 
  1. ITB (iliotibial band)
  2. quadriceps muscle
  3. hamstring muscle
  4. tensor fascia lata
  5. calf (gastrocnemius) muscle

Muscles to Strengthen
  1. Quadriceps (primarily the VMO)
  2. Hip adductors

Patient Education

Avoid stair-climbing and sitting for prolonged periods of time.


This is just an example of what treatment should include.  Depending on your individual case, your specific treatment may be altered.  Although it is important to stretch and strengthen your muscles even when no injury is present, don't try to remedy Patellofemoral Pain yourself.  If you are experiencing symptoms described above, see your physician immediately to get you into a rehabilitation program as soon as possible.