By Dr Zeinah Keen
Patellofemoral syndrome is the most common cause of knee pain in the population (American Academy of Family Physicians, 2017). It can be caused by overuse of the knee joint, physical trauma, or misalignment of the kneecap.
Patellofemoral syndrome happens when the back of the kneecap comes into contact with the thigh bone. The exact reason this occurs is not entirely understood, but it is linked to:
• Overuse of the knee: Activities that involve running or jumping put a repetitive strain on the knee joint, which can lead to pain in the patella.
• Muscle imbalance: When certain muscles, such as those around the hip and knee, are weak, they fail to keep adjacent body parts, including the kneecap, properly aligned. This may eventually lead to injury.
• Trauma: Injury to the kneecap, or knee surgery, may increase the risk of experiencing patellofemoral pain syndrome.
The pain can be worse for running, squatting, walking up and down stairs, kneeling or sitting for extended periods of time. In conjunction to pain, they may be slight swelling to the affected area, a feeling of grinding when bending or straightening the leg and a reduction to the strength in the thigh and glut muscles.
Common risk factors for patellofemoral syndrome include:
• Age: Adolescents and young adults are at the highest risk of patellofemoral syndrome, although it may also affect older adults.
• Sex: Women are more likely than men to develop this condition, possibly due to greater risk of muscle imbalance and the wider angle of the female pelvis.
• High-impact activities: Engaging in high-impact or weight-bearing activities, including running, jumping, or squatting causes repetitive stress.
• Flat feet: This places additional stress on knee joints.
Most of the information is elicited throughout the case history and examination.
In some cases, imaging tests, such as X-rays and MRI scans, may be ordered to confirm a diagnosis and rule out other conditions.
There are several treatments available when someone has patellofemoral syndrome, including:
For many cases of patellofemoral syndrome, simple measures, such as rest and ice, may be enough to alleviate pain and swelling.
The RICE protocol, standing for Rest, Ice, Compression, Elevation, involves resting the leg, applying ice packs regularly, using compression bandages, and elevating the knee above heart level. The RICE protocol is most effective when used within 72 hours of injury.
Over-the-counter anti-inflammatory medications, can help to reduce the pain and swelling associated with patellofemoral syndrome. These should not be taken on long-term basis due to the risk of gastrointestinal problems.
Osteopathy can help to accelerate your recovery whilst alleviating symptoms. Techniques utilised may include myofascial release, massage, trigger point needling, adjustments to the pelvis as well as mobilisation techniques to the ankles, knees and hips. Trigger point needling and taping may also be used, as well as exercise and stretch prescription.
In addition, maintaining muscle balance, correcting flat feet, having a healthy weight, warming up before workouts, changing training regimens gradually and avoiding unnecessary stress to the knee, are some life style factors which may need to be addressed as part of a treatment plan.
Surgery is usually carried out using an arthroscope, a thin tube containing a camera and light. The scope is inserted into the knee, and surgical tools are used to remove damaged cartilage.
This minimally invasive procedure can increase mobility and relieve tension.
Severe cases of patellofemoral syndrome may involve an operation on the knee to change the direction that the patella passes over and rubs against with the femur.
Recovery time varies between individuals and depends on factors that include the severity of the symptoms, the cause of the problem, patient compliance and the treatments used.
For most, the recovery is a few weeks but can take several months to completely recover, especially if the patellofemoral syndrome was brought on by physical trauma.
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