It starts as a dull, aching pain in the front of the knee. Perhaps you notice it when you walk down the stairs or squat or when you struggle to get up after prolonged sitting. Eventually, it begins to hurt when walking, running, and skiing, which impacts how you participate in these activities. If left untreated, quality of life can start to deteriorate as you find yourself avoiding activities you once enjoyed.
As one of the most active cities in North America, Bend, Oregon, sees its fair share of sports and orthopedic-related conditions, and patellofemoral pain syndrome is up near the top. We interviewed Bend physical therapist Scott Weber, who is an expert at helping his patients overcome knee pain to better understand this common condition and how to prevent and treat it.
Patellofemoral pain syndrome is one of the most common causes of knee pain. The pain associated with it comes from dysfunction or tissue degeneration where the patella slides up and down on the groove of the femur as you bend and straighten the knee.
“The patella should slide up and down the center of the groove in the femur, but improper alignment can cause it to go off to the side a bit, causing abnormal compression.”
Scott Weber, PT, CLT
The condition is also known as runner’s knee because it is most commonly seen in people who participate in high-impact sports such as running. But this doesn’t mean that all runners have bad knees. Quite the contrary is true as running can help strengthen the muscles surrounding the knee. BUT, if there is a structural defect that is exacerbated by running, you will likely damage or wear down the cartilage behind your knee.
Why Does Patellofemoral Pain Syndrome Happen?
Typically, patellofemoral pain syndrome is caused by a structural defect that causes abnormal tracking of the patella that causes it to not glide correctly in the groove of the femur. This can cause an irregular distribution of force under the patella, which over time can sometimes result in degenerative changes of cartilage, showing up later as chondromalacia. The majority of the time, the abnormal tracking is due to abnormal mechanical movement patterns of the leg, such as:
- Internal rotation of the leg
- Knees dropping in
- Feet pronating/flat arches
- Tight hamstrings
- Weak thigh muscles
- Kneecap that is too high in the knee joint
- Tight Achilles tendon/poor ankle mobility
- Poor foot support
- Overuse
- Injury
Understanding Chondromalacia Patella
As patellofemoral pain worsens, you may seek out your healthcare provider for help. Often, they will prescribe imaging. Chondromalacia patella is diagnosed if there is degeneration of the cartilage on the underside of the kneecap. The severity of the cartilage softening is graded on a scale of one to four, with four being the most severe.
Physical Therapy and Knee Pain
Physical therapists are movement experts, and since patellofemoral pain syndrome is rooted in abnormal tracking of the patella, they are perfectly positioned to treat it. Scott recommends that if you’re having anterior knee pain frequently, see a physical therapist sooner rather than later.
During a PT evaluation, the provider will assess the structures around the patella to see if tissues are pulling on it in any way or if the position of the patella is not correct. They will also assess the stability and integrity of the other structures around the knee and the entire body’s alignment.
Treatment for patellofemoral pain syndrome (and even chondromalacia) typically involves range of motion exercises, loading exercises, neuromuscular control exercises, and exercises that retrain the leg to move mechanically appropriately. They may also include Kinesio taping to help the knee track better and reduce pain. A PT may also recommend low resistance cycling as it allows the knee to track normally when the leg is in correct alignment.
“Most problems are driven by abnormal forces that cause abnormal movement patterns, resulting in pain and can eventually lead to degenerative changes,” said Scott. “Despite this, as physical therapists, we can still make improvements – even with degenerative tissue, which can heal and remodel to tolerate a healthy distribution of weight on the patella.
If you’re struggling with knee pain, schedule an evaluation with a physical therapist. Together, you can build a program that helps you achieve your physical goals so you can return to experiencing every day without knee pain.