Video presented by Grant Cooper, MD
This video accompanies: Causes of Knee Pain Video
Patellofemoral syndrome is a common cause of knee pain. It generally presents as anterior knee pain, or pain in the front of the knee. Patellofemoral syndrome is a problem with the tracking of the kneecap within the knee. Essentially, here’s a knee, and this the patella of the knee cap. And there’s a groove in which the knee cap is supposed to glide as one goes through life bending, flexing, walking, and sitting. When the knee cap doesn’t track in that groove properly, you can get some friction and some inflammation on the bottom of the knee cap that can lead to a little knee arthritis, chondromalacia patella, some irritation of the knee cap, and that can be painful. Typically, it’s going to present as pain in the front of the knee.
It’s usually very painful when you go down the stairs when patients have patellofemoral syndrome. When people sit for a long time, they’ll often feel like they have to straighten their knee because the pressure builds and when you straighten the knee, the pressure relaxes. Patellofemoral syndrome is primarily a biomechanical problem, so that way you go about treating it is by addressing the biomechanics. Typically this means stretching the hip flexor, stretching the iliotibial band, which comes down the outside of the leg and attaches down at the bottom of the knee and can pull the knee cap to the side.
Typically when the knee cap is not tracking properly it is tracking laterally, or tracking to the outside of the knee. And then strengthening the quadriceps, ideally strengthening the inside (the VMO, vastus medialis obliquus) in order to get the kneecap back into alignment. Also looking at the feet is important to make sure that if the person has any flat feet or hyperpronation of the feet, that gets addressed as well so that the mechanics get restored throughout the entire kinetic chain.
What are the Treatments for Patellofemoral Syndrome?
While the hallmark of treating patellofemoral syndrome really is addressing the biomechanics, as you’re going through physical therapy, if the pain is getting in the way of getting better or participating in physical therapy, then there are oral medications that one can take in order to help with the pain of some of the inflammation.
There are topical prescription medications like Voltaren® gel, Pennsaid®, Flector® Patch, which are basically topical diclofenac, topical non-steroidal anti-inflammatory drugs like Advil® or Aleve®. These diffuse right through the skin, and that can be somewhat helpful as well with patellofemoral syndrome. It’s not going to fix it, because again, we really need to address the mechanics, but it can help along the way.
In a similar vein, one can do different kinds of injections like hyaluronic acid injections, which is basically putting some joint fluid into the joint in order to help lubricate the joint, which again is not going to fix the biomechanics but can help open this window of opportunity during which the patient can participate more fully with physical therapy and break through a plateau in order to really make a full recovery.