What is patella-femoral pain?

Patello-femoral pain describes pain under and around the patella (kneecap). This pain can come on from a number of different activities, but occurs most commonly with impact sports such as running. Patello-femoral pain is thought to be brought on by incorrect tracking of the patella (mal-alignment) or due to inflammation of the joint. The main factors which lead to patella-femoral pain typically come from above (the hip or lower back) or below (the foot). Occasionally it is bad luck with genetics in terms of bony position! Potential causes include:

  • Over pronation
  • Patellar position/size
  • Tight muscles causing a twist through the knee joint
  • Reduced hip or core strength
  • Training error – too much too soon
  • Hills and stair training

Pain is normally aggravated by going upstairs, squatting, prolonged sitting (“movie goers sign”) and running. There is normally no swelling evident around the knee, sometimes there may be clicking around the joint. One or both knees may be affected, and it is more common in girls, particularly adolescents.

How is it treated?

Treatment for patello-femoral pain involves correcting the factors which have led to the mal-tracking or inflammation of the synovium.  This may involve soft tissues releases/dry needling plus of tight muscles around the patella-femoral joint, mobilisation of the patella-femoral joint, stretching/use of muscle release roller and strengthening of weak stabilising muscles of the pelvis and knee.

Biomechanical factors such as over-pronation may be addressed with the prescription of orthotics. Kinesio or rigid tape is also useful in correcting patellar position, offloading soft tissues and stimulating muscle response.

Your physio can also provide guidance on appropriate return to training and advice on a graduated increase in training intensity and duration.

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