Shedding Some Light on Patellofemoral Pain Syndrome

Davis Kos-Whicher
5 minutes ago
4 min read

By Davis Kos-Whicher, physiotherapy exam candidate

Patellofemoral pain syndrome, or PFPS, can be described as general or diffuse pain around the kneecap. Sometimes referred to as chondromalacia patellae, which is more often used to describe an X-ray or MRI of the kneecap. Knee pain of any kind can be a frustrating experience, impacting your day-to-day activities such as crouching, kneeling, and squatting, or more athletic endeavours such as running and jumping. This blog post will dive into some basic anatomy of the knee joint, common reasons for patellofemoral pain, and some exercises anyone can try to help with their knee pain.

Anatomy:

The knee joint, although seemingly simple, has more complexity to it than a simple hinge joint. With a small ability to rotate in and out, and the addition of the kneecap (when compared to an elbow) it is no wonder knee pain is so common. Now, the main joint we are referring to is the patellofemoral joint. The patellofemoral joint is the interaction between your knee cap and the groove of your femur. The function of this joint/the patella is to improve the strength of our knees with extension movements (kicking, squatting, running, etc.).

Patellofemoral pain is when this interaction between the knee cap and the femur is disrupted or irritated. This could be from several reasons that influence how the patella tracks in the femur’s groove.

Reasons for patellofemoral pain:

Possible reasons for abnormal tracking, pain, discomfort, or irritation of this joint can be due to both intrinsic and extrinsic factors.

Intrinsic factors	Extrinsic factors
- Quadriceps weakness or tightness - Lateral hip & glute weakness - Elevated or lowered patella - Increased Q-angle - Lateral retinaculum tightness - Calf tightness or weakness - Decreased ankle dorsiflexion - Excessive foot pronation/supination	- Sudden increase in activity or training load, volume, or frequency - Sudden change in activity surface - Sudden change in footwear or improper footwear - Sudden weight gain

Intrinsic factors:

Although there are several different factors in this table that may seem concerning, most of the items on this list are modifiable. It is good news that, with a little patience and discipline, items involving weakness, tightness, and joint restriction can all be improved through strength and mobility/flexibility training. Another important point is to consider how many items are not specifically the knee. Only two items on this list directly involve the patella itself. The rest of the items involve either the hip or the foot/ankle. Doing exercises for the hip, ankle, and knee can both be extremely important for improving pain and function in patellofemoral pain syndrome^1,2.

Extrinsic factors:

The external factors differ from internal factors by being behavioural in nature. Our bodies tend to be constantly searching for a state of balance. Although we may aim to increase our activity or engage in positive health habits, sometimes the change can be drastic and result in pain. I will provide an example to illustrate this better. Jane is a person who has recently listened to a podcast discussing step counts. In this podcast, the hosts mentioned the various health benefits of reaching 10 000 steps daily. Jane has a sedentary job and regularly gets 2000-3000 steps per day. For the next 5 days, she increased her step count to 10 000 and by day 5 is experiencing anterior knee pain. Now, could it be that Jane has any of the internal factors mentioned previously? It is possible. However, it is likely that making a jump of 6000-7000 steps per day exceeded the capacity and tolerance of her lower body, resulting in knee pain.

It is important to consider that many activities could result in an example similar to Jane. Activities such as running, walking, kneeling, squatting, and even sitting alter the load being placed on the lower body and could influence the presence of pain. Research tends to recommend gradual changes in activity and loading for knee pain ³. This could look like wearing your new shoes for a few hours each day before using them full time, or in Jane's case, adding an additional 1000 steps per week for several weeks before reaching 10 000.

Exercises:

Below are several exercises that may help strengthen and alleviate your knee pain.

1) Wall-sit at 70 degrees: 2-3 sets 20-45 seconds

- Start with your feet about shoulder width apart and slide yourself down the wall until your hips are slightly above your knees

- Maintain your back and hips contact with the wall throughout the allotted time

- For an easier alternative shorten the amount of time held or do not squat as deeply.

2) Side plank: 2-3 sets 20-45 seconds

- Lay on your side, place your elbow underneath your shoulder and by engaging your core and glute muscles lift your hips up so that your hips, shoulders and ankles are straight.

- For an easier alternative bend your knees and allow them to be in contact with the floor instead of the sides of your ankles

3) Calf raises: 2-3 sets 6-12 reps

- Set yourself up so that you can hang on to something for balance. Have your heel floating off an edge and allow your ankle to sink down until you feel a stretch in your calf.

- Push through the ball of your foot to come back up

- For an easier alternative start from the floor instead of having a floating heel.