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Patellofemoral Pain Syndrome
Patellofemoral Pain Syndrome (PFPS) also known as runners knee, chondromalacia patellae, anterior knee pain and patellofemoral joint syndrome is a generic term used to describe pain at the front of the knee and around the knee cap.
Symptoms include an aching pain in the knee joint, particularly at the front of the knee around and under the patella. There is often tenderness along the inside border of the kneecap and swelling will sometimes occur after exercise. Patellofemoral pain is often worse when walking up and down hills or sitting for long periods of time.
Other signs a sports medical practitioner may pick up include a click or cracking sound when bending the knee, wasting of the quadriceps muscles if the injury is an old one and tight muscles around the knee joint.
Patellofemoral pain is common in people who do a lot of sport and in particular adolescent girls. It can have a number of causes. It is often thought that incorrect tracking of the patella over the femur bone resulting in damage or irritation of the articular cartilage is a significant factor.
Damage to the cartilage itself cannot directly cause pain because there are no blood vessels or nerves. However it can lead onto other problems which in turn cause pain. These include synovitis which is inflammation of the synovial membrane or joint lining in the knee, erosion of the cartilage and bone, soft tissues injury or irritation such as to the lateral retinaculum and the infra patella fat pad.
The initial cause of patellofemoral pain syndrome is likely to be over use or increased forces on the joint. This may be from external factors for example a sudden increase in training, or performing high intensity jumping and knee bending, or it can be from internal factors such as poor patella tracking. Identifying the cause is and important part of treatment.
See PFPS assessment for more detailed information on the numerous causes.
Treatment and rehabilitation is based around reducing pain, identifying the causes and strengthening or re-training muscles which may have contributed to the injury.
Apply RICE (Rest, ice compression and elevation) after activity to help reduce pain and swelling. Rest completely from aggravating activities until there is no pain.
Wearing a patella tracking knee brace or support may help. These usually have a hole in the middle for the kneecap and straps which are pulled across the knee applying support to the patella. Patellofemoral taping techniques can help reduce pain by altering the tracking of the patella.
A professional practitioner can confirm the diagnosis and rule out other conditions which may have similar symptoms such as a synovial plica. A doctor may prescribe anti-inflammatory medication such as ibuprofen which should not be taken if you have asthma.
Sports massage can help loosen tight structures and muscles which may be contributing. Gait analysis can also be done to determine if the athlete overpronates and orthotic inserts can correct poor foot biomechanics. In chronic cases a surgeon may operate to release the tight lateral structures of the knee although there is little evidence as to the success of surgery.