Sore Knees - Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is a common knee condition. If you have this condition, you will feel pain under and around your kneecap, which can get particularly annoying going up or downstairs, after sitting in a car or movie theatre for prolonged periods, or bending down to a squatting position.

Patellofemoral refers to the joint that includes the kneecap (patella) and the thigh (femur). The exact aetiology of PFPS is unknown, general literature and clinical experience suggest that the cause is multifactorial including:

· Overuse/overload as bending the knee increases the pressure between the patella and its various points of contact with the femur. This explains how prolonged sitting can be painful (movie-goers knee).
· Biomechanical factors including excessive pronation (flat feet), Supination (high arched feet) and muscular causes such as weakness of the quadriceps, hip muscles, hamstrings or ITB.

Excessive pronation causes a compensatory internal rotation of the tibia or femur that can cause malalignment of the patellofemoral mechanism this is the premise behind using orthotics as a treatment. The person with a supinated or high arch foot provides less cushioning for the leg when it strikes the ground this places more stress on the patellofemoral joint, in this case good cushioning shoes and often prescription orthotics can be very helpful. Muscular causes can be due to either weakness or inflexibility of the quads (especially vastus medialis), hip, hamstring or ITB muscles or secondary to biomechanical factors, these issues should also be addressed and may require physiotherapy and gym rehabilitation.

The initial conservative approach to patients with PFPS should include 1) relative rest with maybe change to a non-impact activity, 2) Ice, especially after activity (this may be supplemented with a prescribed anti-inflammatory) and 3) evaluation of biomechanics and possibly orthotic and footwear treatment possibly coupled with physio or gym rehabilitation.