Knee pains are common and can be irritating as well, since one’s daily routine can be negatively affected. Patellofemoral pain is the medical term used when pain occurs at the front of the knee, around the patella (kneecap), without signs of any damage or other problems in the knee joint. It is also called patellofemoral syndrome.
What causes patellofemoral pain?
It can be due to a combination of different factors, which put extra strain on the knee joint, and on the surrounding muscles and ligaments.
Situations where this can occur include:
Overuse of the knee, such as in certain sports – particularly at times of increased training. Some people may have a slight problem in the alignment of the knee. This may cause the patella to rub on, rather than glide over, the lower femur. It may be due to the way the knee has developed. Or, it may be due to an imbalance in the muscles around the knee – for example, the large quadriceps muscle above the knee. If one side of the quadriceps muscles pulls harder than the other side, then the patella may not glide properly and may rub on one side.
A combination of an alignment problem and overuse with sports – may be the most common reason for getting this pain. Foot problems can play a part – for example, where the feet do not have strong arches (flat feet). This makes the foot roll inwards (pronate), which means the knee has to compensate for the inward movement. Also, shoes with hard, rather than springy soles, put more strain on the knee.
Injury to the knee – including repeated small injuries or stresses due to sports, or slack ligaments (hypermobile joints). Reduced muscle strength in the leg can contribute, as the leg muscles will be less able to absorb stresses on the knee.
Who gets patellofemoral pain?
Almost anyone; it can occur in children from about age five onwards, and in adults, as it is a common cause of knee pain.
Pain around the knee. The pain is felt at the front of the knee, around, or behind the kneecap. Often, the exact site of the pain cannot be pinpointed; instead the pain is felt vaguely at the front of the knee.
The pain comes and goes. It tends to be worse when going up or down stairs, or with certain sports. Also, it may be brought on by sitting still for long periods. For example, after going to the cinema or a long drive. There may be a grating or grinding feeling or noise, when the knee moves. This is called crepitus. Sometimes there is fullness or swelling around the patella.
The diagnosis is made from your symptoms, the history of the problem, plus a doctor’s examination. Tests such as X-rays or scans cannot diagnose patellofemoral pain, and are not helpful, although they may sometimes be used to look for other conditions.
In the short term
Avoid strenuous use of the knee – until the pain eases. Symptoms usually improve in time if the knee is not overused. Aim to keep fit, but to reduce the activities which cause the pain. You may use painkillers – paracetamol and or anti-inflammatory painkillers. Anti-inflammatory painkillers are often helpful for this type of pain.
In the longer term
The aim is to treat some of the underlying causes – for example, by strengthening muscles and helping with foot problems through:
Physiotherapy , which will improve the strength of the muscles around the knee, and ease the stress on the knee. Also, specific exercises may help to correct problems with alignment and muscle balance around the knee. For instance you may be taught to do exercises which strengthen the inner side of the quadriceps muscle. You may also be taught exercises to stretch tight ligaments. The physiotherapist can give advice tailored to your individual situation.
Use of appropriate footwear/aids, such as arch supports if you have flat feet; suitable shoes if you are running; or springy soles which reduce strain when walking.
Taping of the patella is another option which may help reduce pain. Adhesive tape is applied over the patella, to alter the alignment, or way the patella moves. Some people find this helpful. Some physiotherapists offer patellar taping treatment.
A special brace can be used too for assisting with pain reduction. Surgery is not often used for patellofemoral pain. However, it may be helpful in certain situations, like correcting the alignment of the patella by releasing a tight ligament.
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