What is Patellofemoral Pain Syndrome?

The patellofemoral joint is made up of the fossa where the patella slides between the two femoral condyles. The word patella means a small dish in greek. The word condyle means “knuckle”, and is one of the pair of rounded thing on the end of bones. PFP is also known as runners’ knee or Chondromalacia patellae. The word chondromalacia is derived from the Greek chrondros, meaning cartilage and malakia, meaning softening.

So, PFP is when the articular cartilage on the backside of your knee softens because it has rubbed too much on the surface of one of your femoral condyles. It is aggravated by most activity which involves knee bending conditioned on how much force your quad is exerting at the time, which will grind your patella into the condyle as you’re moving. Patellofemoral articular cartilage cannot directly be a source of nociception, as it is avascular and aneural. However, a cartilage lesion may lead to chemical or mechanical synovial irritation, edema, or erosion- all of which can result in pain. So, the goal is to let the articular cartilege harden back up, which will then let the synovium around the area calm down.

Techniques to treat PFP

Taping

When?

Whenever there’s a big risk of rubbing?

Why?

In the short term, patella taping speeds the onset timing of the VMO relative to the vastus lateralis

How?

Youtube video

Orthodics

Why?

Orthodics might reduce the amount of force needed to supinate the foot when the heel hits the ground, which might let the muscles on the outside of the leg work less hard. Salsa

How?

Foot orthotics & pronation retraining through training the extrinsic foot muscles (?). But probably just orthotics

Hip strengthening

Why?

To stop internal hip rotation. Do I have internal hip rotation?

How?

lunge, step up and step down

Quad Strengthening

When?

The patient should perform small numbers of exercises frequently throughout the day.

Why?

To yoink the patella medially. Note that there is no exercise which always strengthens the VMO over the vastus Lateralus

How?

Step up and step down while concentrating on the VMO

Acupuncture

When?

The acupuncture treatment done in this 1999 study was repeated twice weekly for 4 weeks.

Why?

The increased nociceptive sensation from areas close to the knee may result in a reflex inhibition of the quadriceps contraction and muscle wasting. This may lead to an extensor dysfunction due to a neurophysiologic motor control imbalance between the flexors and extensors and between the muscles in the quadriceps.

How?

All were needled locally at ST-34 and SP- 10, and either Extra point Lower Extremity-5 and ST-35 or SP-9 and ST-36. Other points used were BL-17, 18, 20, 23; LI-4; CV-4. Each session lasted 20 to 25 minutes, and the needles were initially manipulated until de-qi was obtained. De-qi is described as an aching sensation More info on the acupuncture points here.

Mobilisation

Stretching tight lateral structures such as the lateral retinaculum is beneficial. This is best done in a side-lying position with the knee flexed. The therapist glides the patella medially using the heel of the hand for a sustained stretch.