Let’s talk about kneecap pain.
Patellofemoral Pain Syndrome (PFPS) is a broad terminology that captures a variety of kneecap pain diagnoses. Because of this, it is important to remember that PFPS is not a tissue-specific diagnosis.
Instead, PFPS is used to label movement dysfunction that is resulting in kneecap pain.
I’ll explain a bit more…
Your kneecap (patella) is
The patella moves with the knee. When you bend your knee your patella slides downward, and as you straighten your knee it slides up. When these kinematics are off, it can lead to kneecap pain.
The angle formed by the knee relative to the hip is called the Q angle. This tends to be larger in women when compared to our male counterparts. A greater Q angle predisposes us to a greater likelihood of developing PFPS, which is why it is more commonly seen in women.
Working Up The Chain
What we are seeing now is that more often than not, the knee is not the true cause of the kneecap pain. Stick with me…
The knee is a hinge joint meaning it moves forward and backward with little additional mobility. The hip and ankle, however, move a whole lot more.
For this reason, when someone presents with non-traumatic kneecap pain we immediately look at the hip and ankle for any kind of dysfunction. Imbalances in either of those two joints can easily work their way up/ down the chain and the knee happens to be a vulnerable breaking point.
This is why you will notice that little kneecap pain treatment has to do directly with the knee. The joints above and below (most commonly the hips) are what actually need to be trained up.
Let’s dig a little deeper.
When muscles on the sides of the hips are not doing their job we get something called knee valves (aka knock knees). This is caused by your femur bone moving toward midline while your tibia moves further away.
This change in mechanics can put a lot of stress on your knees and bring on kneecap pain.
Overuse: Overuse is the most common cause of PFPS. Any increase in activity or adoption of a new activity can lead to overuse of unprepared structures.
Poor Mechanics: This tends to go hand in hand with overuse. Poor body mechanics can place excess strain on tissues that aren’t meant to withstand that load. This is often due to weakness in hips and/ or decreased ankle and trunk stability.
Trauma: A direct blow to the kneecap can also injure tissues causing similar symptoms.
- Gradual onset
- Pain after sitting for a long period of time (movie sign)
- Pain going up and down stairs (down is worse than up)
- Kneecap pain
- Locking/ clicking/ catching in the knee
- Pain with kneeling/ squatting
Tests Your PT May Do
Step Down Assessment: You will begin standing on a step and your therapist will ask you to step down with the non-impaired limb. He/ she will be watching the movements that occur at your knee when you perform this movement.
Single Leg Stance: Your therapist will have you stand on the affected limb to assess your balance, specifically the movement at your ankle needed to maintain that balance.
Single-Leg Squat: Similar to the step down, your therapist will have you perform a small squat on one leg while assessing the movement and pain levels at your knee.
Patellar Tracking: Your therapist will look at how your kneecap moves when you contract the quad muscles that move it.
Landing Mechanics: Starting on a small box, you will be asked to
Taping and Orthotics
Not necessarily a permanent solution, but one that can get your some more relief in the short-term.
You can easily pick up a knee brace over the counter at a local pharmacy. There is no need for customized fitting. I would suggest not wearing the brace when performing treatment exercises because we want
Taping can also be used to assist with decreasing kneecap pain in the short-term. Your physical therapist will be able to help you to apply the tape correctly. It should be noted that research does not support the idea that tape can be used to correct kneecap alignment, but it can have a
Stretching is important not only for the muscles surrounding the knee but
Getting the hips nice and strong is the main objective treating kneecap pain. As I mentioned before, the hips control the knee. The lateral hip musculature (i.e. glute med) is a particularly important player in this.
Bonus: Check out my previous post on the 7 Best Glute Building Exercises for an added challenge once your pain has subsided.
In the early stages of your PFPS
It will get better the
BUT, do limit how much you are bending your knees, especially in weight-bearing exercises (i.e. squats, lunges). Listen to your body and don’t try to push through the pain. If you can only get to a
Kneecap pain is not fun, but it is treatable.
Hip strengthening has been shown to have a positive effect on PFPS and can be performed without aggravating the knees.
Swap out the deep squats for some clamshells while your tissues are healing. You will be back in no time!
In need of a physical therapist to help you through your PFPS rehab? In the Portland, OR area? Come work with me!
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