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What are the symptoms of Patello-femoral knee pain?

Symptoms include pain in the front of the knee, ‘inside’ the knee and sometimes at the back of the knee, which is worsened by putting weight on the leg when in the bent position. For example, when walking up or down stairs, kneeling, squatting, and you often feel stiff after prolonged sitting with your knees bent.

Sometimes you can feel the knees giving way, where the knee can’t support your weight. This is a response to pain rather than actually weakness. This is because of a protective mechanism where your brain inhibits the muscles to stop you using your knee to avoid further damage. (This reflex is so effective that some people never feel the pain, just the feeling of the knee giving way.) This condition could be classified as early wear and tear and could be a precursor to osteoarthritis if left untreated. It can affect people of all ages but tends to be more common as we get older. Sometimes when the cartilage on the kneecap is worn you can hear grating and cracking (crepitus) when bending the knee. It is usually associated with swelling of the knee ranging from mild to moderate. Sometimes the swelling is more prominent at the back of the knee causing a Baker’s cyst.

Why do we get patello-femoral pain?

The patella is a moveable bone that sits between the thigh bone (femur) and shin bone (tibia) and provides an increased mechanical lever for the tendon attaching to it. It is attached to the knee via tendons of the large muscle in the front of the thigh called the quadriceps, which performs the action of straightening the knee.

Underneath the patella is articular joint cartilage. This covering helps the patella move smoothly over the thigh bone as the knee bends and straightens. The knee cap is v-shaped underneath and has two articular surfaces. It is supposed to sit in the middle and slide up and down the middle of the groove in the thigh bone. Poor alignment of the patella combined with overuse can cause inflammation and degeneration of the joint cartilage underneath the kneecap (patella). If this cartilage becomes damaged you will feel pain.

What are the causes of patello-femoral pain?

Patellofemoral pain is often a consequence of patella tracking disorders i.e. an imbalance, which causes the kneecap (patella) to move out of place as you bend and straighten the knee. This puts more pressure on the articular cartilage.

Muscles surrounding the knee, the vastus medialis obliqus (VMO) and the vastus lateralis, help the patella hold its position on movement. An imbalance in these muscles can cause problems. The alignment of the knee, or the Q-angle which is the angle between the thigh bone and the lower leg when looking from the front, can also predispose you to tracking problems. The Q-angle can vary from one person to the next and can vary from one side to the other. It tends to be greater in women. This can be further aggravated if you have poor hip stability. For example, if your hip abductors (gluteus medius) are weak or inhibited it will allow your knee to rotate inwards when you run resulting in knee pain. It is often aggravated by carrying excess weight. Either your own body weight or additional weight from equipment or luggage. It can also be aggravated by congenital variations of the kneecap.

In some cases people are born with congenital variations of the knee, which put them at risk of developing patellofemoral pain including variations in shape, size and location of the patella. The way you walk can also be a factor. Overpronation or “rolling the foot inward excessively” can put increased pressure on the knee joint leading to patello femoral pain. The use of supportive orthotics, or insoles, are often beneficial in this case. Previous trauma and associated scar tissue can have an affect on how your knee is moving and therefore predispose you to pain. Poor technique and equipment in the sport or activity you perform can also be a cause. For example, how you align your hip, knees and feet when squatting, running and cycling.

How do Chiropractors treat patello-femoral pain?

Chiropractic treatment will always address the underlying cause of any problem. It is very important to treat the cause of the problem and not just the symptoms or the pain will simply reoccur. We will assess you for any underlying functional, structural, congenital variations and identify areas of muscle weakness, tightness and imbalance, which need to be corrected to maximise long-term improvement and prevent reoccurrence. This will include your spine and pelvis and lower limb.

We will also check your lower limb alignment including your feet for the need of orthotics. Help you with exercise technique and advise you on equipment. The first step is to get the pain under control and allow the injured structures to heal. It is therefore necessary to modify what you do and we start appropriate exercise early to prevent unnecessary weakness and deconditioning. We use specific chiropractic manipulation and mobilisation techniques to areas of restricted movement in the knee and surrounding joints to improve the function. We use modalities such as laser, ultrasound and interferential therapy to speed up the healing. When appropriate we will increase the level of rehabilitation exercise to help you get back to normal activities as quickly as possible. Knee bracing and taping can be beneficial for some patients.

How long will it take to get better? Patello-femoral pain can take time to heal and there is no set time for recovery. The rate of recovery depends very much on your ability to heal, the severity of the injury, how long it has been present and your compliance to treatment. If the underlying cause of the problem is not corrected you can start to develop osteoarthritis or” wear and tear” on the surface of the kneecap.

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