What is Patellofemoral Pain?
Knee cap pain, more formally known as patellofemoral pain (PFP), is one of the most common injuries of the knee. It is an overuse condition which typically comes on gradually.
Location of pain: around or under the knee cap (patella).
Nature of pain: It typically presents as an achy pain with some intermittent stabbing in some. Swelling can also be present.
What makes it worse? Activities that load a bent knee such as running, squatting, jumping, and climbing stairs.
Who does it effect? Adolescents through to adults. It is more common in women, but regularly occurs in men too.
What causes it? No two patients are the same and each individual will have a different story as to why they develop their knee pain. Often it is a combination of the following factors:
1. A change to training load:
An increase in the volume, frequency or intensity of our exercise. If we too suddenly introduce a new load on the body, the tissues can not adapt quickly enough to meet the new demand. This can result in overload of the tissues and produce pain. Therefore, we regularly see this in new runners, those returning to running after time off, but also in routine runners who increase their running in preparation for races.
2. Biomechanics:
This is how we move during an activity. So how our hip, knee and foot function during walking, running, squatting etc. Our unique movement pattern can influence how much load/force goes through our knee. Our functional strength can influence our biomechanics as our muscles help us to absorb and exert forces. Studies have identified reduced strength in the hips and quadriceps (thigh) in adults with PFP. This can often be correlated with genu valgus (knocked knees) and further down with pes planus (flat feet), often observed in PFP. This movement patterns of the heel rolls inwards (rearfoot eversion) can influence forces at the knee.
3. Structure of the knee:
Our anatomy! This applies to the shape of our patella and where it naturally sits on the femur.
How do we manage PFP?
Like a lot of overuse injuries, PFP can be challenging to manage and often require a multifaceted approach. This may include a Sports Podiatrist, Physiotherapists and in some cases, a Sports Physician. This pathology has been a popular area of study in recent years amongst researchers. Based off the most recent evidence, we manage should consider incorporating and most possible combine the following management strategies:
1. Knee targeted strengthening exercises.
2. Foot orthoses. (Find out how foot orthoses may help in our next blog)
3. Lower quadrant manual therapy.
4. Knee and hip targeted strengthening exercises.
5. A combined approach of the above.
In Summary
Current scientific evidence recommends we use a combined approach in managing PFP. This includes a specific strengthening program, modifications to training and adjunct therapies including foot orthoses. So, consider booking with a Podiatrist who will work together to get you pain free and moving in the right direction.
Written by Sports Podiatrist Alice Corbett B.Pod, MSc (SEM)