Patello Femoral Pain' is one of the most commonly presented orthopaedic musculoskeletal conditions. PFPS may account for 11% of musculoskeletal pain complaints and up to 25% of all injuries are in runners.
Risk Factors for Patello Femoral Pain Syndrome include:
- Anatomic Anomalies (e.g. hypoplasia of the medial patellar facet, patella alta)
- Malalignment and altered biomechanics of the lower extremity (static or dynamic)
- Muscle dysfunction (e.g. quadriceps weakness, improper firing pattern)
- Patellar hypermobility
- Poor quadriceps, hamstring, or iliotbial band flexibility
- Tight lateral structures (i.e. lateral retinaculum and iliotibial band)
- Aberrant foot mechanics such as hyperpronation
- Training errors or overuse - Trauma
- Localised muscle weakness often medial muscles e.g. vastus medialis obliqus
- Poor hip and pelvic stability e.g. gluteus medius weakness.
- Physical anomaly such a hip retroversion and increased q-angle
- Poor footwear e.g. poor arch support/heel cup
- Previous Surgery
Treatment:
A detailed assessment of the imbalances of patellar tracking is essential to tailoring treatment. The success rate of treatment for patients wit PFPS is largely dictated by patient compliance. One of the key components of treatment is that the patient rests sufficiently from ANY activity that increased their pain until they are symptom free.
Treatment may involve:
- RICE (Rest, Ice, Compression, Elevation).
- Support strapping
- Exercise therapy to strengthen and lengthen the quadriceps and lengthen the iliotibial tract
- Neuromuscular injury prevention strategies, including proprioceptive training.
- Gentle Patella joint mobilisation and correction of lumbar-pelvic biomechanics.
- Muscle activation work to improve hip extension, motor patterns and running technique.
- Massage to increase flexibility and range f movement directed towards soft-tissue structures, reducing foot pronation
- Education for awareness and avoidance of supposed risk - Activities which place large amounts of stress through the patella-femoral joint should be minimised, these include: squatting, jumping, running and going up and down stairs.
- Exercising into pain must also be avoided. This allows the body to begin the healing process in the absence of further tissue damage. Ignoring symptoms or adopting a "no pain, no gain" attitude is likely to lead to the problem becoming chronic.
- A well-structured tailored rehabilitation program is the mainstay of treatment. Specific exercises can be prescribed as part of a home rehabilitation program. Some patients may require significant strengthening of the quadriceps. Others may have excellent quadriceps strength but excessively tight lateral structures or poor quadriceps flexibility. Soft tissue techniques and flexibility exercises can be helpful for these patients.
Immediate, appropriate treatment in patients with patella-femoral pain syndrome is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times. If you ever wish to discuss our treatment protocols, or co-management of patients, please do not hesitate to contact our practice.