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Patellofemoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome (PFPS)

It doesn’t matter how new or experienced you are at running - injuries don’t discriminate. Patellofemoral pain syndrome (PFPS), also known as chondromalacia patella or anterior knee pain, is one of the most common injuries for all kinds of runners. Patellofemoral pain syndrome is an overuse injury, which means that it is caused by repetitive stress to the knee joint without letting it rest or heal.

How common is patellofemoral pain syndrome?

According to the British Journal of Sports Medicine, patellofemoral pain syndrome mainly affects younger runners who run for recreational purposes, and it strikes twice as many women as it does men. This could be because women tend to have wider hips, placing the kneecap under more pressure from the greater angling of the thighbone to the knee.

How can you get patellofemoral pain syndrome?

It’s difficult to specify a single cause of anterior knee pain. It could be a result of biomechanical problems. For example, if your patella happens to sit too high in the femoral groove, if it is larger on the outside than the inside, or if it’s prone to dislocation, all of these things could increase your chances of getting patellofemoral pain syndrome.

Biomechanics elsewhere can also affect the patella. If the cartilage in your knee joint is worn down, this will reduce shock absorption, and it could also be worsened if you have high-arched feet, which give less cushioning to impacts. Equally, flat feet or knees that turn in or out too much can also pull the patella sideways, causing it to rub.

There are also muscular causes of chondromalacia patella. Tight muscles in the thigh or calf put pressure on the knee, and weak quads can shift the patella out of alignment. If you have any of these muscle or biomechanical faults, the repetitive impact of a normal running stride can be enough to provoke a case of PFPS.

What does it mean to have anterior knee pain?

You can get patellofemoral pain syndrome in either or both of your knees at the same time, and this can be linked to previous injuries, overuse of your knees, or the previously mentioned muscle weakness and biomechanics. The pain tends to be a dull kind of ache, which is usually made worse by bending or putting pressure on the knee joint. Even sitting still for prolonged periods of time could cause pain. PFPS can be aggravated by steps, inclines and uneven terrain.

Symptoms of PFPS include a kind of tenderness behind or around the patella towards the centre of the knee cap. There might also be a feeling that your knee is cracking or giving out entirely, which can be very upsetting.

How can it be treated?

You can perform certain stretches and exercises to help with anterior knee pain, but since most patellofemoral pain syndrome is caused by some biomechanical fault, you’ll have to make permanent changes to how you run in order to stop it from recurring. Nevertheless, stretches can help where there is a muscular cause, and this can certainly relieve pressure on the knee while it heals.

Stretch your hamstring by standing in front of a chair, high step, or bench and placing your heel on it. Keeping your back straight, lean forward from the hips until you feel a stretch down the back of your leg. Hold this for 30 to 60 seconds before switching sides and repeating.

Straight leg lifts can also be effective. Lying on your back, bend your left knee and place your left foot on the ground. Meanwhile, take around three seconds to lift and lower your right leg, keeping your knee relatively straight. Perform ten repetitions of this before switching legs.

What can be done to prevent it from coming back?

Patellofemoral pain syndrome can be a sign of biomechanical problems or movement faults, which means you’ll need to make adjustments to how you train and how you run in order to stop it from happening regularly. The most important step to take is to cut your mileage right back at the first sign of pain, preferably stopping running altogether. The sooner you lessen the strain and stress on your knee, the faster and smoother the healing process will be.

Stick to the 10 per cent rule when you’re building your mileage back up: don’t increase your mileage more than 10 per cent per week. Be especially careful with running on hills, and introduce hill work into your training regimen gradually. It can also help to use a smaller stride on hills.

Seeing a physiotherapist will help determine whether there are any problems with your gait that could be causing the chondromalacia patella. Simple adjustments can be made, such as finding new running shoes or orthotics that are more suitable for your gait, while you might also need a lengthier program of physiotherapy to fix any more complex problems.

Final thoughts

It’s important to get a good diagnosis from a doctor or physiotherapist who is experienced with sports injuries if you think you have patellofemoral pain syndrome, as there are a wide range of knee injuries that runners can suffer from that present similar kinds of pain but need different treatments. Another condition that can be easily mistaken for PFPS is iliotibial band friction syndrome (ITBFS), which occurs when the iliotibial band rubs against the outside of the femur as your knee straightens and bends while you run.

The iliotibial band is a very thick band of connective tissue that stretches from the outside of the pelvis, down past the knee joint, to the outside of the shin bone. As you move your knee, this band can rub against the femur and become inflamed, causing intense pain. The main difference in symptoms between ITBFS and PFPS is that pain from ITBFS is generally focused laterally across the knee and can even extend up the iliotibial band to the upper thigh. In contrast, PFPS pain presents more behind the kneecap toward the centre of the knee and can be accompanied by a cracking feeling. Because the pain of ITBFS is due to inflammation, you can often see a slight swelling.

Ultimately, the differences between ITBFS and PFPS are very subtle, and it takes an experienced doctor or physiotherapist to note these differences and treat them accordingly. Whether it’s due to a biomechanical cause, the result of simple overexertion, or a combination of both, a good physiotherapist will help you to adjust your training regimen to accommodate your injury and build yourself back up to full strength.

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