Patella Femoral Syndrome: Why Does Your Knee Hurt?

Patella Femoral Syndrome is a common knee injury among athletes and active people. Also known as Patella Femoral Pain Syndrome and Patella Femoral Compression Syndrome, it is characterized by pain around the kneecap that increases with activities.



Understanding the symptoms of Patella Femoral Syndrome, what causes this condition, and ways to help prevent it can significantly help to keep you off the sidelines.

What is Patella Femoral Syndrome?

It is a very complex condition, often with several different contributing factors. Boiled down to the basics, it centers around the patella, and the way that it tracks within the femoral groove. To understand this, lets take a closer look at the patella femoral joint anatomy.

The patella is a small bone that sits on the end of the femur. The femur has a shallow groove in which the patella moves up and down during knee flexion and extension (bending and straightening).

The quadriceps muscles are the large muscles on the front of your upper leg, and all four connect to the patella, and then the patellar tendon connects them to the lower leg.

Everytime the quadriceps contract, the patella moves along the femoral groove.


With patella femoral compression syndrome, the patella is not quite centered within the groove. This can be due to several factors, which we will discuss in a minute.

As the quads contract, the patella moves along the groove, but if it is not aligned correctly, there are areas of greater pressure, and areas of lesser pressure. Repetitive activities often cause irritation of the patella and surrounding structures, because of this mal-alignment and abnormal pressures.

As irritation increases, you begin to have pain around the kneecap, and eventually have a continual ache throughout the knee with all activities.

Learn more about knee anatomy...

Signs and Symptoms of PFS

The most common complaint with patella femoral syndrome is pain, located on the sides of the kneecap. You may also have discomfort under the patella. There may be a grinding feeling, or occasional popping of the knee as well. Swelling is not very common with patella femoral syndrome, however, it can occur.

Running, sprinting, jumping, going up and down stairs, and squatting are all things that can increase patella femoral pain. Most sports involve running and jumping, so you can easily see how this can cause your knee to hurt.

Rest will usually make your knee feel better, however, without fixing the underlying problems causing the malalignment of the patella, your pain is going to return once you start playing again.

What Causes Patella Femoral Syndrome?

There are many different causes of patella femoral syndrome, and it is impossible to pinpoint one specific cause in every person. The most common causes include structural mal-alignments, poor flexibility, strength deficits at the quads, hips, and core, and biomechanical issues at the foot and ankle. Lets talk about each of these in a bit more depth.

Structural mal-alignments focus on the way your body is built. Every person is a bit different. Because your body is a very complex machine, made up of lots of levers and "pulley" systems, alignment within these systems is very important. However, there is very little that can be done to change structural alignment, other than surgery.

The good news is that by increasing flexibility and strength of certain muscle groups, your alignment issues can be overcome. If you have wider hips, or "knock-knees" you are more likely to suffer from patella femoral syndrome because the way the quadriceps pull on the patella during knee motion. Other common alignment issues include the size of the patella, and where the patella sits in the femoral groove at rest.

Poor flexibility can also cause patella femoral syndrome, especially tight hamstrings and calf muscles.

The hamstrings are the large muscles on the back of the upper leg. When they are tight, they place an increased amount of stress on the knee, hips, and lower back.

This increased stress forces the quadriceps to work harder, and can alter the way the patella rides in its groove.

Flexibility of the hip rotator muscles is also important, as these muscles are responsible for helping to control the femur and provide a stable base for the patella to move upon. Unfortunately, mobility at the hips is often overlooked in patella femoral rehab.


Weak muscles can contribute to patella femoral compression syndrome as well. This is true for the quadriceps, as they are the primary muscles that move the patella along the groove. While quadriceps and VMO strength is important, it is not as essential as hip strength.

Even more important are the muscles of the hips and the core. Imagine the patella as a train, and the femur as the track. Everyone knows that a train will run safely as long as it has a stable track. The number one cause of train wrecks is a problem with the track. The same is true for the patella.

As long as your femur (the track) is stable, then your patella will work effeciently and safely. If the muscles controlling your femur are weak and cannot keep it stable, your patella is bound to wreck, causing all kinds of problems. Strengthening of your hip rotators is vital for treating and preventing patella femoral syndrome, because these are the muscles that control your femur.

Because the body is interconnected from the tips of your toes to the top of your head, the biomechanics at your ankle and foot are important to consider when trying to figure out knee pain.

The foot is our first point of contact with the ground when you walk, run, or jump. The structural alignment of the foot determines how much stress is transferred up the leg, as well as the direction of this stress.

Pronation and supination at the foot can often contribute to problems at the knee and hip, and patella femoral syndrome is no exception. If you over pronate at the foot, you may suffer from patella femoral syndrome.

How do you treat PFS?

Because patella femoral syndrome is a very complex condition, with many different possible factors causing the problems, it is important that you seek medical attention from your certified athletic trainer or family physician.

Rest will help reduce your pain and discomfort, but will not address the underlying problem. Your athletic trainer should be able to pinpoint specific things that are causing your pain, and then design a rehab program to address these problems. A good rehab program should consist of flexibilityand mobility exercises, strengthening exercises, especially for the hips and core, and balancing exercises. The use of a knee brace or orthotics may be necessary depending on the structural alignments present.

Rest and ice are the first steps in treating your patella femoral syndrome. Ice will help to reduce inflammation in your knee, and to reduce pain. Rest from aggravating activities reduces the stress on the area and allows for recovery. But remember, you must fix the underlying problem in order to recover completely.

Since patella femoral pain syndrome is a chronic problem that takes time to recover from, I recommend to my patients an ice compression wrap for their knee.

It is a re-useable ice pack that provides both cold and compression, two essential components of the R.I.C.E. principles. R.I.C.E. Principles The best ice compression wrap on the market is made by Cold One. They offer an unconditional 30 day guarantee, and provide a great product that will help reduce pain and inflammation.

Ebay is a great place to find knee braces and ice compression packs for treating your patella femoral synrome.

Summary

Patella femoral syndrome is a complex and common knee injury. It is best treated with guidance from a certified athletic trainer or physical therapist, who understands the complexity of the injury and the proper ways of addressing the many different causes. Proper warm up and stretching, as well as a conditioning program focused on hip and core strength can help you prevent this condition. If conservative rehabilitation fails, surgical options include a lateral release.

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