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Patellofemoral Syndrome treatment and information
Written by: James Gill BOst GOsC 6039. Registered Osteopath, Founder & Clinic Director
Medically Reviewed: Yannick Gracia, M.Ost GOsC 10475. Registered Lead Osteopath
Your knee is the largest joint in your body and one of the most complex. It is made up of the lower end of the femur (thighbone), the upper end of the tibia (shinbone), and the patella (kneecap). Ligaments and tendons connect the femur to the bones of the lower leg. The four main ligaments in the knee attach to the bones and act like strong ropes to hold the bones together. Muscles are connected to bones by tendons. The quadriceps tendon connects the muscles in the front of the thigh to the patella.
Patellofemoral syndrome is a condition that describes pain in the front of the knee and around the kneecap, known as the patella. Specialists may also call patellofemoral syndrome “jumper’s knee” or “runner’s knee.”
What are the symptoms of Patellofemoral Syndrome?
The main symptom associated with patellofemoral syndrome is a dull, aching pain that usually occurs on the front of the knee. The pain may be in one or both knees. It often worsens with activity.
Other symptoms can include:
- Pain during exercise and activities that repeatedly bend the knee, such as climbing stairs, running, jumping, or squatting.
- Pain on the front of the knee after sitting for a prolonged period of time with your knees bent, such as one does in a movie theater or when riding on an airplane.
- Pain related to a change in activity level or intensity, playing surface, or equipment.
- Popping or crackling sounds in your knee when climbing stairs or when standing up after prolonged sitting.
What are the common causes of Patellofemoral Syndrome ?
The causes leading to this syndrome are still unclear in some cases, but a few possibilities are mentioned below:
Over use of the quadriceps muscles – The overuse of the quadriceps is the most common cause leading to patellofemoral syndrome. Repetitive activities such as running or jumping, can put an increased impact and tension through the knee. This can lead to an irritation of the patellar tendon, resulting in patellofemoral syndrome.
Direct injury or trauma on the knee – can create a fragility of the area, predisposing to patellofemoral syndrome.
Patellar Malalignment Some people have a kneecap that abnormally tracks in the groove at the end of the femur. This can cause extra pressure on the cartilage covering the kneecap or on the femur where it rubs, called the trochlear surface.
Factors that can contribute to the maltracking of the knee cap include:
Weakness or muscle imbalances of the quadriceps muscles – Muscle imbalances in the quadriceps can cause poor tracking of the kneecap as it articulates through the trochlear.
Instability or imbalance in the lower extremity – can also lead to an irritation of the tendon. The nature of the imbalance can vary from an unstable ankle on running/jumping activities for example to a domination of the inner thigh muscles in opposition to the muscles on its external border which leads to a maltracking of the kneecap. also responsible for a similar irritation.
How is Patellofemoral Syndrome diagnosed?
- Questions about the history of the injury (traumatic or not)
- Aggravating or relieving factors?
- The onset of the symptoms?
- Have there been any recent changes to your training intensity?
Do I need to go to the GP or visit my local hospital?
You don’t need to visit a local hospital for such symptoms as knee pain located under the kneecap, as it is very likely this can be managed by your GP or a specialist consultant. A chiropractor, physiotherapist or an osteopath for example can see you in a consultation and with their anatomical knowledge and experience can appropriately answer your questions.
What are the treatment options for Patellofemoral Syndrome ?
There are two different categories of treatment recommended for a patellofemoral syndrome: conservative intervention or surgical intervention.
Conservative treatment can consist of a selection of different self help remedies along with exercises, prescription and physical therapy. Below is a non-exhaustive list of conservative treatment options for the management of patellofemoral syndrome.
RICE – Reducing pain and inflammation around the knee. RICE stands for rest, ice, compression and elevation.
Medication – your GP may suggest taking non-steroidal anti-inflammatory (NSAIDs) medication to help with reducing pain levels and inflammation. Examples of NSAIDs include ibuprofen.
Activity Change – altering or reducing exercise that aggravates your knee will reduce pain and enhance recovery time. Opting for lower impact activities such as swimming or stationary bike is ideal. As your knee pain improves higher impact exercise can be reintroduced.
Exercise prescription – A personalised exercise designed by a registered chiropractor, physiotherapist or an osteopath can be used to help strengthen the patella tendon and stabilise both the knee and ankle of the affected side.
Osteopathy, Chiropractic and Physiotherapy – Hands on physical therapy can be used to help assess and treat areas of weakness and instability within the knee joint complex. A treatment plan can then be put in place to help restore strength, mobility and function helping with pain reduction. Many different techniques may be used to do this,including: joint mobilisation and articulation, soft tissue release and guided exercise prescription.
Surgical intervention
Surgical intervention is very rarely needed and only recommended in cases where conservative treatment has not been successful. Some of the surgical options available include:
- Arthroscopy – this type of surgery consists of the “cleaning” and decompression of the affected knee, using small incisions and cameras for guidance.
- Tibial tubercle transfer – this type of surgery consists of the alignment of the kneecap moving the patellar tendon along with a portion of the tibial tubercle.
How long does Patellofemoral Syndrome last?
Can Patellofemoral Syndrome be prevented?
What are the best exercises for Patellofemoral Syndrome*?
The exercises below are designed to help with the recovery from patellofemoral syndrome. The aim of the exercises are to stabilise the affected limb, strengthen the patellar tendon and help staying active even during the acute phase of the symptom presentation. Here are 3 example exercises:
Wall sits isometrics. A basic exercise but used for many knee injury rehab programs. Place your whole back against the wall, with a mild flexion of both hips and knees, averaging 120 degrees. Lift one leg up off the floor, so your bodyweight is only resting on one leg. Hold this position for 15 to 20 seconds depending on the difficulty of doing the exercise and/or your pain level. This exercise can be repeated 3 times for each leg.
Wobble board stability. A basic exercise consisting of standing, one leg at a time, on a wobble board (can easily be found online or in sports shops), with a mild knee bend (to unlock the knee joint and make the muscles work more efficiently). Ensure to find your stability, resisting the collapsing of the ankle inwards, or the body weight shift towards the outside. Can be done every 2 days, aiming to work on each leg for approximately 10 mins in total, with an extra 5 mins focus on the “weaker”, affected leg.
Cycling (during recovery phase). Cycling (either on a moving bicycle or on an indoors static one) is a very good exercise to maintain a level of activity and movement in the affected knee during the acute (most painful) phase of the symptoms presentation. Ideally, the activity session on the bike shouldn’t be longer than 30-45 mins at a time, in order to ensure the knee and mainly the quadriceps muscles are active and loaded, without stressing the patellar tendon.
*It is recommended to get the go ahead from your physical therapist or GP before carrying out any of these exercises.
Patella Tendinopathy: A Related Condition
Patellofemoral Syndrome vs. Patella Tendinopathy
Your knee is a complex joint, and pain around the kneecap can have several causes. Two common conditions affecting this area are Patellofemoral Syndrome and Patella Tendinopathy. While they share similar symptoms, they involve different structures and require slightly different treatment approaches.
Patellofemoral Syndrome (Runner’s Knee / Jumper’s Knee)
- Origin of pain: From the kneecap (patella) as it tracks over the femur.
- Causes: Often caused by muscle imbalances, poor patella alignment, or repetitive bending activities such as running, jumping, or squatting.
- Symptoms: Dull ache at the front of the knee, worsened by squatting, climbing stairs, or prolonged sitting; occasional popping or crackling sounds.
- Treatment: Managed with osteopathy, chiropractic care, or physiotherapy to address muscle imbalances and alignment, combined with quadriceps and hip strengthening exercises, activity modification, and in rare cases, surgery.
Patella Tendinopathy (True Jumper’s Knee)
- Origin of pain: From the patellar tendon, just below the kneecap.
- Causes: Typically develops due to repetitive overload or high-impact activities like jumping, running, or squatting.
- Symptoms: Localised sharp or aching pain directly below the kneecap, worsened by jumping or sudden movements.
- Treatment: Focused on tendon rehabilitation through physiotherapy, osteopathy, or chiropractic care, including eccentric loading exercises, activity modification, shockwave therapy (radial / focused shockwave), and sometimes bracing to support recovery.
Key Difference:
- Patellofemoral Syndrome = a kneecap/joint problem.
- Patella Tendinopathy = a tendon problem.
Understanding the difference is crucial to ensure the correct treatment plan is followed. Your osteopath, physiotherapist, or GP can accurately diagnose which condition you have and design a rehabilitation programme specifically tailored to your needs.
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