Patella Femoral Syndrome is a common knee injury among athletes and especially runners. Also known as Patella Femoral Pain Syndrome and Patella Femoral Compression Syndrome, it is characterized by pain around the kneecap, generally increased with running or jumping.
Understanding the symptoms of Patella Femoral Syndrome, what causes this condition, and ways to help prevent it can significantly help to keep you training.
What is Patella Femoral Syndrome?
Patella Femoral Pain Syndrome is a very complex condition, often with several different contributing factors. Boiled down to the basics, it centers around the patella, and the way that it tracks within the femoral groove. To understand this, let’s take a closer look at the patella femoral joint anatomy.
The patella is a small bone that sits on the end of the femur. The femur has a shallow groove in which the patella moves up and down during knee flexion and extension (bending and straightening).
The quadriceps muscles are the large muscles on the front of your upper leg, and all four connect to the patella, and then the patellar tendon connects them to the lower leg. Every time the quadriceps contract, the patella moves along the femoral groove.
With patella femoral syndrome, the patella is generally not quite centered within the groove. This can be due to several factors, which we will discuss a little later. As the quads contract, the patella moves along the groove, however, if it is not aligned correctly, there are areas of greater pressure, and areas of lesser pressure.
Running and jumping often cause irritation of the patella and surrounding structures, because of this mal-alignment. As irritation increases, you begin to have pain around the kneecap, and eventually have a continual ache throughout the knee with all activities.
Signs and Symptoms of Patella Femoral Syndrome
The most common complaint with patella femoral syndrome is pain, generally located on the sides of the kneecap. You may also have discomfort under the patella. There may be a grinding feeling, or occasional popping of the knee as well. Swelling is not very common with patella femoral syndrome, however, it can occur.
Running, sprinting, jumping, going up and down stairs, and squatting are all activities that commonly increase patella femoral pain. As most sports activities involve running and jumping, you can easily see how this can cause problems with participation.
Rest will generally relieve symptoms, however, without addressing the underlying problems causing the misalignment of the patella, your pain is bound to return once you resume activities.
What Causes Patella Femoral Syndrome?
There are many different causes of patella femoral syndrome, and it is impossible to pinpoint one specific cause in every person. The most common causes include structural mal-alignments, poor flexibility, strength deficits at the quads, hips, and core, and biomechanical issues at the foot and ankle. Lets talk about each of these in a bit more depth.
Structural mal-alignments focus on the way your body is built. Every person is a bit different. Because the body is a very complex machine, made up of lots of levers and "pulley" systems, alignment within these systems is very important. However, there is very little that can be done to change structural alignment, other than surgery.
The good news is that by increasing flexibility and strength of certain muscle groups, alignment issues can be overcome. Generally speaking, athletes with wider hips, or "knock-knees" are more likely to suffer from patella femoral syndrome due to the way the quadriceps pull on the patella during knee motion.
Other common structural alignment issues include the size of the patella, and where the patella sits in the femoral groove at rest.
Poor flexibility can also be a cause of patella femoral syndrome. This is especially true with tight hamstrings and calf muscles. The hamstrings are the large muscles on the back of the upper leg. When they are tight, they place an increased amount of stress on the knee, hips, and lower back during activities.
This increased stress forces the quadriceps to work harder, and can alter the way the patella rides in the femoral groove. Flexibility of the hip rotator muscles is also important, as these muscles are responsible for helping to control the femur and provide a stable base for the patella to move upon.
Weak muscles can contribute to patella femoral syndrome as well. This is true for the quadriceps, as they are the primary muscles that move the patella along the groove. However, even more important are the muscles of the hips and the core. Imagine the patella as a train, and the femur as the track.
Everyone knows that a train will run safely and efficiently as long as it has a stable track. But the number one cause of train wrecks is a problem with the track. The same is true for the patella. As long as the femur (the track) is stable, then the patella will work efficiently and safely. But if the muscles controlling the femur are weak and cannot keep the femur stable, the patella is bound to wreck, causing problems.
With this in mind, strengthening of the hip rotators is vital for treating and preventing patella femoral syndrome.
Because the body is interconnected from the tips of your toes to the top of your head, the biomechanics at the ankle and foot are important to consider when looking at the knee. The foot is the first point of contact with the ground during activities, and the structural alignment of the foot determines how much stress is transferred up the leg, as well as the direction of this stress.
Pronation and supination at the foot can often contribute to conditions at the knee and hip, and patella femoral syndrome is no exception. Athletes who over pronate at the foot often suffer from patella femoral syndrome.
How do you treat Patella Femoral Syndrome?
Because patella femoral syndrome is a very complex condition, with many different possible factors causing the problems, it is important that you seek counsel from an expert. Again, rest will help reduce your pain and discomfort, but will not address the underlying problem.
Your physician, physical therapist, or athletic trainer should be able to pinpoint specific things that are causing your pain, and then design a treatment program to address these problems.
A good treatment program should consist of flexibility exercises, strengthening exercises, especially for the hips and core. The use of a knee brace or orthotics may be necessary depending on the structural alignments present.
Rest and ice are the first steps in treating patella femoral syndrome. Ice will help to reduce inflammation in the area, and to reduce pain. And rest from aggravating activities reduces the stress on the area and allows for recovery. But remember, you must address the underlying problem in order to recover completely.
Summary of Patella Femoral Syndrome
Patella femoral syndrome is a complex and common knee injury. It is best treated with guidance from an expert, who understands the complexity of the injury and the proper ways of addressing the many different causes. Proper warm up and stretching, as well as a conditioning program focused on hip and core strength can help prevent this condition
Shane Doll is a certified Charleston Personal Trainer, fitness expert, speaker, author, and founder of Shaping Concepts Personal Training Studios. Learn more how you can receive a FREE no-obligations trial of his Charleston personal training programs and experience the Shaping Concepts difference for yourself.
