PATELLOFEMORAL SYNDROME

DEFINITION:

MECHANISM OF INJURY / HOW IT OCCURS:

Patellofemoral syndrome is often a result of mal-alignment of the patella leading to excessive stress and subsequent pain.
Overuse and overtraining can lead to this syndrome especially in those individuals with malalignment.
Often seen in those participating in climbing as well as descending activities such as stair and hill training.
Also seen in activities such as running, kneeling, and squatting.
More recently seen in snowboarders, especially those performing jumps.

SYMPTOMS:

Individuals will experience pain at the front (anterior) of the knee.
Symptoms are exacerbated with ascending and descending stairs and hills. Kneeling, squatting as well as sitting for prolonged periods of time.
Crepitation (grinding) with flexion and extension.

DLIAGNOSIS:

Physical examination will reveal anterior knee pain, crepitation, as well as increased symptoms when the individual kneels or squats. With compression of the patella symptoms will increase.
Evaluation for genu valgum (knock-knees), foot pronation, and a poorly developed vastus medialis obliquus (VMO) muscle.
Radiographic studies may demonstrate patella malalignment.

TREATMENT/REHABILITATION:

Initially rest and anti inflammatory medications (NSAIDs) are recommended.
Physical therapy specifically addressing strength and stretching issues is begun. Quadriceps and hamstring flexibility as well as VMO strengthening are emphasized. (See exercises for patellofemoral syndrome).
Bracing and taping modalities may be utilized.
Cross training and gradual resumption of activities is recommended.
For those individuals with flat feet, shoe inserts should be considered in addition to appropriate shoe wear (See recommendations under footwear for runners).
The last resort, in those who do not improve, is surgery to correct any mal-tracking that may exist.