Patellofemoral pain syndrome is a very common diagnosis in orthopedics and sports medicine to describe pain in the front of the knee and around the patella, or kneecap. Other names include: “runner’s knee” or “jumper’s knee” because it is common in people who participate in sports—particularly females and young adults. The pain and stiffness it causes can make it difficult to climb stairs, kneel down, and perform other everyday activities.Often times, patients will describe a “dislocation” type feeling to the kneecap.
Symptoms are often relieved with conservative treatment, such as changes in activity levels or a therapeutic exercise program.
In many cases, patellofemoral pain syndrome is caused by activities that put repeated stress on the front of the knee —such as jogging, squatting, and climbing stairs. An increase in the frequency of activity, can also be in the duration or intensity of activity—such as running longer distances.
Patellofemoral pain syndrome can also be caused by abnormal tracking of the kneecap in the trochlear groove. In this condition, the patella is pushed out to the outside or lateral side of the groove when the knee is bent. This abnormality may cause increased pressure between the back of the patella and the trochlea, causing pain and inflammation.
Muscular imbalances or weaknesses, especially in the quadriceps muscles at the front of the thigh. The most common is the VMO or vastus medialis obliquus muscle. When the knee bends and straightens, the quadriceps muscles and quadriceps tendon help to keep the kneecap within the trochlear groove. Weak or imbalanced quadriceps can cause poor tracking of the kneecap within the groove.
The RICE Method
RICE stands for rest, ice, compression, and elevation.
- Rest. Avoid putting weight on the painful knee.
- Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly on skin.
- Compression. To prevent additional swelling, lightly wrap the knee in an elastic bandage, leaving a hole in the area of the kneecap. Make sure that the bandage fits snugly and does not cause additional pain.
- Elevation. As often as possible, rest with your knee raised up higher than your heart.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help reduce swelling and relieve pain.
Specific exercises will help you improve range of motion, strength, and endurance. It is especially important to focus on strengthening and stretching your quadriceps since these muscles are the main stabilizers of your kneecap. Core exercises may also be recommended to strengthen the muscles in your abdomen and lower back.
Bracing can also help to keep the patella centrally tracking within the groove and allow patients to stay active while they continue to rehab and strengthen the quadriceps.