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Patellofemoral Pain | Exercises and Interventions
Introduction
Patellofemoral pain syndrome (PFPS), known as “runner’s knee,” is common among athletes, active individuals, and even those with sedentary lifestyles. Patella malalignment or tracking is thought to be the primary problem that causes this type of pain. The pain is typically localized to the front of the knee and originates from behind the kneecap (patella). However, it is not unique to runners and also affects those sports that involve repetitive knee bending, like cycling, basketball, and volleyball. PFPS can affect many individuals, making it one of the most common conditions we see in sports medicine and rehabilitation.
Prevalence and Risk Factors
Research suggests that PFPS accounts for 25-40% of all knee problems seen in a sports injury clinic. [2] In addition, women tend to be more susceptible than men because of some of their anatomical differences, like a wider pelvis, which can affect the alignment. [2] These are a few PFPS risk factors that have been proposed:
Muscle Weakness
- Weakness of the quadriceps, gluteus maximus, and medius (hip abductors) have all been shown to contribute to malalignment. When these hip and thigh muscles are all working correctly, they can control the femur (thigh bone) so that the patella fits in the groove without abnormal stress.
Biomechanical Issues
- Improper alignment of the knee from either a wider pelvis, as mentioned before in women, or flat feet can form a more knocked knee position.
Improper Training
- Repetitive activities like running, jumping, or heavy squat lifting can be a source of stress to the patellofemoral joint.
Structural Abnormalities
- Hypermobility of the patella or a shallow trochlear groove in which the patella tracks could result in a subluxations of the patella.
Improper Footwear and Training
- Improper-fitting shoes that offer no arch support can cause excessive foot pronation, which can cause alignment issues. Running on uneven terrain and hard surfaces can also cause abnormal stress on the patella.
Exercises and Intervetions
Fortunately, effective treatment options can help alleviate patellofemoral pain. The challenge is that everyone has unique circumstances, so the approach is most effective when individualized. Here are a few exercises we prescribe for home and interventions we use in our clinic.
1. Activity Modification
Before embarking on any form of exercise it will be important to control the amount of stress placed through the knee. Overuse or improper form can quickly lead to further complications down the line. Listening to your body and allowing adequate recovery time will improve the healing process. This strategy alone will result in a reduction of pain.
2. Single Leg Glute Bridges
- Lay on your back with hips and knees bent with both feet on the floor.
- Lift one foot off the floor and straighten the knee.
- With opposite leg, activate your gluteal muscles and raise your hips to be inline with your knees and shoulders.
- Hold for 2-3 seconds, then slowly lower.
- Repeat 10-15 times for 2-3 sets.
3. Sidelying Hip Abduction
- Lying on your side using elastic resistance, lift your leg toward the ceiling, and keep good alignment.
- Hold for 2-3 seconds, then slowly lower.
- Repeat for 10-15 times for 2-3 sets.
4. Single Leg RDL
- While standing on one leg and holding a light dumbbell or kettlebell, bend forward, hinging at the hip, and keeping your back straight.
- Perform the movement slowly with good control. Repeat 10-15 times for 2-3 sets.
5. Quadriceps Strengthening
Strengthening the quadriceps can be challenging when the knee is painful. These are 2 examples we use to begin the process:
1. Shallow Split Squats:
- Start in a standing position with feet shoulder width apart.
- Step forward with one foot.
- Bend both knees, making sure the knee of the lead leg does not bend in front of the toes.
- Push upward until the knees are straight and bring the lead leg back underneath you.
- Repeat 10-15 times for 2-3 sets.
1. Terminal Knee Extension:
- Start by placing a resistance band securely in a door at knee height.
- Loop the band behind your knee on the affected side.
- Allow the knee to bend slightly.
- Keeping your knees over your feet, tighten the muscles in the front of your thigh and slowly straighten your knee back to a standing position.
- Once fully straightened repeat for 10-15 times for 2-3 sets.
6. Patellofemoral Taping
- Research has shown that taping can be be a helpful adjunct to traditional exercises for treating PFPS. [2]
7. Blood Flow Restriction (BFR)
- We often use Blood Flow Restriction therapy when pain limits the load we can use for strength training. By applying a tourniquet to the thigh at an individualized amount of pressure, we can gain an effective response without using heavy resistance.
Frequently Asked Questions:
1. Can I continue to run or exercise with patellofemoral pain?
- Like most things, it depends. Certainly, if your activity continues to make the pain worse, stop and rest, allowing your tissues to recover. If the pain is not worsening then consider reducing the volume of exercise or running distance, consider running on softer terrain and take a closer look at your footwear.
2. How long does it take to recover from patellofemoral pain?
- That also depends on whether it is acute vs. chronic injury. If diagnosed properly, and a good plan of care is implemented, 6-8 weeks is usually sufficient to return to your desired activity. Like most things, the longer you wait, the longer it takes. Compensations and weakness begin to develop, and sometimes, there may be more extensive damage to the involved tissues.
3. Is surgery ever required for patellofemoral pain?
- With out improved understanding of the disorder, surgery is rarely required. However, if therapy and other conservative measures fail after several months, surgery may be considered, but it is the exception, not the rule.
Conclusion
Patellofemoral pain can be frustrating and limiting, but it can be effectively managed with the right approach. The most effective strategies are individually designed after a thorough evaluation. Strengthening the muscles around the knee, improving flexibility, and using targeted intervention like patellar taping and BFR are all excellent strategies to reduce pain and restore the normal function of your knee. Whether you’re and athlete, an active adult or someone dealing with everyday knee pain, incorporating these exercises and interventions can help your regain pain-free movement.
In Good Health,
The Salinas PT Team
References:
[1] Barton, C. J., Lack, S., Hemmings, S., Tufail, S., & Morrissey, D.** (2015). *The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain: Incorporating Level 1 Evidence with Expert Clinical Reasoning*. British Journal of Medicine, 49(14), 9 and 23-934.
[2] Crossley, K. M., van Middelkoop, M., Callaghan, M. J., Collins, N. J., Rathleff, M. S., & Barton, C. J.** (2016). *Patellofemoral Pain Consensus Statement from the 4th International Patellofemoral Pain Research Retreat, Manchester.* British Journal of Sports Medicine, 50(14), 844-852.
[3] Boling, M. C., Padua, D. A., Marshall, S. W., Guskiewicz, K., Pyne, S., & Beutler, A.** (2009). *A Prospective Investigation of Biomechanical Risk Factors for Patellofemoral Pain Syndrome: The JUMP-ACL Study.* The American Journal of Sports Medicine, 37(11), 2108-2116.
[4] Witvrouw, E., Callaghan, M. J., Stefanik, J. J., Noehren, B., Bazett-Jones, D. M., Willson, J. D., Neal, B. S., & Crossley, K. M.** (2014). *Patellofemoral Pain: Consensus Statement from the 3rd International Patellofemoral Pain Research Retreat Held in Vancouver, September 2013.* British Journal of Sports Medicine, 48(6), 411-414.
[5] Collins, N. J., Bisset, L. M., & Crossley, K. M.** (2012). *Efficacy of Nonsurgical Interventions for Anterior Knee Pain: Systematic Review and Meta-analysis of Randomized Trials.* Sports Medicine, 42(1), 31-49.
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