This information has been prepared to help you fully understand your condition so you will be in the best position possible to work with your physio and follow the steps to your full recovery. Understanding the goals of your treatment and having complete confidence in your physio are vital elements of your recovery plan, so if you have any questions then please feel free to ask your physio.
Patellofemoral pain is a common running injury. It is where the back of the kneecap becomes inflamed because of abnormal rubbing on the end of the thigh bone. It is more common in females than males and also in people who have excess pronation (flat feet). You will often feel pain doing activities like going up and down stairs, squatting, lunging and running. You may also feel pain after sitting for long periods. Physio is the first line of treatment for patellofemoral pain, and we focus on keeping you as active as possible by using tape to control your kneecap position while we correct the underlying cause of your pain.
The patella (kneecap) is the moveable bone on the front of the knee. It is wrapped inside a tendon that connects the large muscles on the front of the thigh, the quadriceps, to the lower leg bone. The underside of the patella is covered with articular cartilage, the smooth, slippery covering found on joint surfaces. This covering helps the patella glide (or track) in a special groove made by the thighbone (femur), called the femoral groove. Two muscles of the thigh attach to the patella and help control its position in the femoral groove as the leg straightens. These muscles are the vastus medialis obliquus (VMO) and the vastus lateralis (VL). /pandgt;
The VMO runs along the inside of the thigh, and the VL lies along the outside of the thigh. If the timing between these two muscles is off or the VMO is weak, the patella may be pulled off track. Muscle imbalance around the hip can also contribute to patellofemoral problems, as can poor foot biomechanics (pronation, or flat feet) during walking and running.
Pain is often felt around the front part of the knee or along the edges of the kneecap, especially in the middle. Others experience vague pain in the knee that isn’t centred in any one spot. Typically pain is experienced when walking down stairs or hills because the quadriceps muscles are under increased load. Keeping the knee bent for long periods, as in sitting in a car or movie theatre, may also cause pain. The knee may grind, or you may hear a crunching sound when you squat or go up and down stairs. If there is a considerable amount of wear and tear you may feel popping or clicking as you bend your knee. The knee may swell with heavy use and become stiff and tight.
Patellofemoral problems start off as irritation of the underlying joint cartilage. If treatment is not started the irritation will persist and may develop into osteoarthritis of the patellofemoral joint. At that stage symptoms can be controlled but the arthritis can’t be reversed. It is unlikely you will be able to return to your sport or normal activity without treatment.
Depending on the severity of your symptoms it may take 2 weeks to several months to get back to full activity. The earlier you begin treatment, the quicker your recovery will be. Usually tape can be used as part of your treatment which means that you are able to return to at least some level of exercise relatively early in your recovery. Often correcting underlying imbalances in muscle length and strength to maintain correct leg alignment takes several weeks to a few months to correct, however your symptoms are usually able be settled down significantly faster than this to allow an earlier return to sport.
Your physio has been extensively trained to thoroughly assess and diagnose your injury. They will give you a step-by-step recovery plan to make your treatment easier for you to understand. The most common phases, or steps, that you will go through during your recovery plan are outlined below. The order and timing of the phases are tailored individually for you and so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.
Inflammation is the redness and swelling that occurs whenever you injure yourself. Our bodies need inflammation to start the normal healing process but we also need to control it.
Your physio will usually advise you on modification of your activity and exercise as well as anti-inflammatory medication if needed. Hands-on treatment may include specific local massage, muscle releases, patella mobilisations and ice. Taping is usually used to control the alignment of your kneecap as you bend and move your knee to decrease the ongoing irritation of the joint cartilage that occurs with patella misalignment.
A major contributing factor in the development of patellofemoral problems is tight structures on the outside of your patella pulling it out of the normal alignment. Two of the main tight structures are the iliotibial band (ITB) and TFL (tensor fascia lata muscle), which run from your outer pelvis to the outside of your knee cap. Restoring full length to these structures is vital to help your current pain settle down, and also an important factor in minimising the chance of problems in the future.
Techniques your physio may use to restore your muscle length include specific soft-tissue releases, home rolling using a foam roller, heat and home stretches.
In order for your patella to maintain normal alignment in the femoral groove the VMO muscle, which attaches to the inside edge of your knee cap, must be strong. This muscle is often weak and poorly coordinated in a painful, swollen knee. Your major hip muscles including your gluteals are also often weak and inhibited, contributing to poor leg alignment and kneecap positioning.
Your physio will guide you through specific exercises to strengthen your VMO and gluteals to get them firing at the right times. We may use EMG biofeedback to help you achieve this. Your home program will be pain-free and fast whilst still being highly effective.
Your biomechanics (how you move) play a big role in causing, resolving and preventing patellofemoral problems. When you have poor foot or hip biomechanics your body is not working as well as it could, and this puts strain on your knee. Correcting your biomechanics will reduce the knee strain and ensure your body is working correctly.
Techniques used to correct biomechanics include specific strengthening, mobility exercises, Gaitscan Custom Orthotics and taping. Shoe assessment is also important, as is review of your hip control and core strength.
Your physio may recommend for you to have a Running Biomechanical Assessment which consists of a video analysis of your running technique and a Functional Movement Screen. Analysing your technique and seeing where corrections can be made can dramatically reduce your injury risk, as well as improve your performance by allowing you to run faster with less effort.
This is the last phase of your journey to full recovery. When you are returning to your activity you must be able to do it at full speed and resistance before being back in the game. You need to be able to apply your speed and force with the correct technique in training first to prevent another injury. In this phase we tailor exercises specifically to your activity by doing advanced sports-specific strengthening and high speed movements combined with rapidly changing directions. This phase is essential both for getting your back to your full level of performance, and also for preventing re-injury due to persisting background weakness or reduced co-ordination of muscle contractions.
Many clients find that seeing one of our Exercise Physiologists, Strength and Conditioning coaches or Personal Trainers is a great way to build strength, ability and confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your stability and strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer and reducing your risk of future injury.