Patellofemoral Pain Syndrome (PFPS)

Knee pain can be a nuisance and disrupt our daily lives as it can impact walking and running. There are various types of knee pains and knowing which type you are experiencing can help you find the right treatments to manage your symptoms.


What is Patellofemoral Pain Syndrome?


Patellofemoral pain syndrome (PFPS) is a common knee problem that is often seen in people who participate in running and jumping sports. More commonly, it is known as runner's knee or jumper's knee. This is due to the fact that this injury is prevalent among runners and athletes such as volleyball or basketball players who perform a lot of jumping movements. Patellofemoral Pain Syndrome (PFPS) is primarily characterized by pain over the front of the knee, but it can also appear in other places. Sometimes it can present above or below the kneecap, behind the kneecap, or even behind the knee.

Anatomy of the knee


The knee joint consists of three bones and two joints. The three bones that make up the knee are the femur (thigh bone), the tibia (shin bone), or the patella (kneecap). The tibial-femoral joint is the joint between your tibia (shin) on the femur (thigh) and the patella-femoral joint is the surface between your femur (thigh) and the patella (kneecap). The knee is made up of many surrounding muscles and ligaments that assist to stabilize the joint as well as aid in its movement. The primary actions of the knee are flexion, which is bending of the knee, and extension, which is straightening of the knee.
The patellofemoral joint is the articulation between the patella (kneecap) and the femur (thigh bone). It is a modified plane joint which is a joint that allows only gliding movements between the joint surfaces. The patella, which is a triangular shaped bone, is embedded in a thick tendon called the patellar tendon. A tendon is what attaches muscle to bone in this case attaches the quadriceps muscles, which is the group of muscles on the front of your thigh to the tibia or shin bone. During movement of your knee and as a result of contraction and relaxation of the quadricep muscles, the patella will glide over the femur. If there is incorrect alignment of the patella as it glides or tracks up and down, it can lead to pain in the knee.

What causes of PFPS?

Typically, pain develops gradually and may worsen over time, but it is also possible for pain to arise from a single incident (such as a direct blow or trauma to the patella like falling and landing right on your kneecap). Some other causes include repetitive use or overload of the joint, muscular weakness (specifically of the hip abductor muscles or quadriceps), and muscle tightness (usually of the quadriceps and muscles around the hips) . Malalignment of the lower extremity, which can present in several different ways can also contribute to patellofemoral pain. These can include people with flat feet (pes planus), high arches (pes cavus), or an increased Q angle which most people would recognize as someone who is ‘knock kneed’. These different variations in people's builds can place stress on the knee in different ways and through overuse or repetitive movements can contribute to patellofemoral knee pain.

I would highly recommend Kody! I had a knee reconstruction surgery and after a year and a half of doing my exercises consistently I didn't see any major improvements. I decided to try Kody out as my brother who had a similar problem had amazing results with him. Kody was able to identify that my lower left side of my back was locked and my left side of my abs was inactive. My visit to Kody was very insightful and after 2 months of working on the exercises I could see major improvements with my strength!

Melissa W. // Vancouver, BC

 

How We Take Care of Your PFPS (Knee Pain)


 
 

With an integrated team of Chiropractors, Physiotherapists, Registered Massage Therapists, Acupuncturists and Kinesiologists, we have you covered for your knee-related problems.


Seeing different practitioners can be helpful as there may be various reasons for your elbow pains. Treatments in a multidisciplinary clinic can help address underlying issues from multiple aspects.

A combination of different treatments can include:
● Soft tissue manipulation to address muscle tightness and trigger points
● Stretching and exercise to manage between treatments
● Chiropractic adjustments to help with stiff joints in the knee, ankle and hip
● Acupuncture and massage therapy to decrease stress in the knee area

If your condition does require further testing or treatment, we can refer you to one of the trusted specialists that we have in our network.


 
 

What are common signs and symptoms of PFPS?

Patients usually present with pain around or behind the kneecap. Pain often presents as an ache in nature but can also be sharp with certain movements or positions.

Pain is often aggravated by activities that increase patellofemoral compressive forces such as going up or down stairs, sitting for long periods of time, kneeling and squatting. Occasionally one might experience a feeling that their knee may give way or buckle on them. Some may also complain of a popping or cracking sensation or sound known as crepitus. This may sometimes be uncomfortable or painful.

What are some ways you can prevent PFPS?

It is important to remember that regardless of what your sport or activity is, it is important to include strengthening as part of your routine to help allow you to perform your activity safely!

During your strengthening it is important to make sure you are executing your exercises using proper technique and form to avoid injury. If you have any specific questions, ask your physiotherapist for help on how you can correct or perfect your form.

Prior to running or any activity, make sure you warm up and get your body ready to go! After you are done with your activity make sure you allow time for a cool down and stretch to help your muscles recover properly. This can help to maintain flexibility and prevent muscles from tightening up. If you are new to running or trying a new activity for the first time, it is a good idea to gradually progress the intensity and not dive in too quickly. This point is important in preventing all kinds of injuries. Lastly, proper footwear is important to provide you with the best support for the activity you are participating in. For more information on what the best footwear for you is, ask your physiotherapist or shoe fitting professional. Since everyone is different, it is always a good idea to get help with finding the shoe that best fits your feet!

I first started seeing Kody last year for some knee pain, and I was immediately blown away by him and his staff. Not only did he work providing relief for the symptom (knee pain), but we worked extensively on fixing some bio-mechanical issues I had. Kody is big on providing clients with the ability to self-manage through specific exercises that work on your weaknesses. He does an amazing job and I can't recommend him enough!

C. Wong // Vancouver, BC

What To Expect During Your First Visit


Meeting with a practitioner for the first time can be a little intimidating. We want you to be as comfortable as possible.

We want to understand what is troubling you so we can treat you effectively. Know that whatever you disclose will be held with the utmost confidentiality.

To determine whether a patient is suffering from Patellofemoral Pain Syndrome (PFPS), the following steps may be taken upon your initial visit with your practitioner:
● a thorough subjective history, including the mechanism of injury, aggravating or relieving factors, the activities you participate in among many other things.
● A complete objective examination to help rule in/out other differential diagnoses. The assessment may include but is not limited to a gait analysis, checking hip and knee range of motion, palpation or touching of the knee and surrounding structures to note any sensitive or tender areas, and finally a functional assessment which may include tasks such as running, squats, stairs or any other tasks that may be important or relevant to the patients
● Provide you with homecare, either an exercise or modification, to complement the treatment
Baseline has taken steps to ensure that all of us are as safe from Covid as possible. We have a pre-screening questionnaire, and we ensure that everyone wears their protective equipment. In between patients, we take the time to properly clean all surfaces that may have been used so that the next patient is safe.

Went to see Kody for a sports injury I’ve been dealing with for a while. Not only did Kody help me heal/strengthen my knee, but also educate me on the injury and how to prevent it from reoccurring. Kody used various techniques/exercises that fit my schedule and lifestyle to help my injury heal. I definitely would recommend Kody as he truly cares for your health and wellbeing. Thanks Kody!

E. Rosales // Vancouver, BC

How can we take care of your knee pain?

Treatment will vary based on how the patient is presenting in the clinic and will depend on the underlying causes and contributing factors that they are presenting with. Generally, rest and activity modification will be prescribed. Ice, taping or bracing and/or orthotics may be prescribed if needed. More common treatment approaches are strengthening and stretching of the muscles identified in the assessment. Often, target areas for strengthening are the hip abductors and the quadriceps. For stretching focus is often on the glute muscles, quadriceps, hamstrings and calves. When the patient is seen in the clinic other treatment options such as manual or hands on therapy and modalities may be used.



You don’t have to live with knee pain

To summarize, elbow pain is common but manageable. Despite there being various reasons why someone can have elbow pain, finding the right modalities and practitioners can help you address the underlying problem and decrease symptoms.

If you resonate with any of these points, give Baseline a call or go online and book an appointment with one of our practitioners.

Written by: Jamie Sonego, Physiotherapist, Vancouver
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