Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome (PFPS) is a form of chronic knee pain that tends inflict people in all walks of life. The root of the problem is believed to be patella maltracking, which means that the patella is not always aligned with the designated surface of the femur. As the knee undergoes repetitive movement throughout the day, the cartilage on the posterior surface of the patella is damaged which can result in immense pain. The silver lining is that often patellofemoral pain syndrome can be treated by correcting imbalances in the muscles acting on the patella.

My Experience

For years I was carrying a lot of extra weight and continued to stay active with high impact activities such as football, basketball and running. At age 20 I would suffer unbearable, spine tingling pain mostly in my left knee. I persisted with my activities as I could not stand not the thought of not competing. But it caught up to me. Eventually my knee specialist diagnosed me with chondromalacia patellae – which meant my patellofemoral pain syndrome had resulted in severe cracks in the cartilage of my patella, which (due to my ignorance of my problem) required surgery.
Following the arthroscopy on my knee, I delved into the treatments for patellofemoral pain syndrome in order to correct my patella tracking problem and prevent future pain and hassle. Here is what I have learnt.

The seesaw

The two culprits in patella maltracking and patellofemoral pain syndrome are predominantly the

1. Vastus Medialis Obliquus (VMO) which is one of the quadriceps muscles
2. Illio-tibial band (ITB)

These two both insert directly into the patella (VMO medially, and ITB laterally) and the correct balance between these two structures maintains correct tracking of the patella throughout the movement.
Most people suffering patellofemoral pain syndrome have a laterally tracking patella. This is due to a weakness of the VMO and tightness of the ITB.

Strengthening VMO

The VMO is predominantly responsible for the last 30 degrees of knee extension. It is also responsible for bringing the knee joint medially during knee extension. These 4 exercises ranging from easiest to more advanced are targeted at improving your VMO’s ability to keep your patella where it should be.

1. VMO knee extensions
2. Ballerina squats
3. Weighted quarter squats
4. Bulgarian split squats

Releasing ITB

At the same time as VMO is being strengthened, ITB can be released or loosened to prevent it pulling the patella laterally during movement.

1. 1. 1. Foam Rolling – Many chronic injuries are due to tightness in a muscle or soft tissue. A foam roller is a great way to help release the ITB. It’s uncomfortable at first but totally beneficial.
      2. The Stick – One of my favourite tools. I’m a big fan of this as an addition to foam rolling. I’m going to write a whole blog post about the stick in the coming days.
      3. Golf Ball Rolling – The “portable foam roller.” Use it the same way on your ITB and massage it in with the palm of your hand.
      4. Stretching – It’s vital to stretch all the muscles acting on the knee joint. There are a few ITB stretches specifically that you can utilise for relief of patellofemoral pain syndrome

Additional advice

1. External knee support – A patella tracking knee support can be useful while you correct your muscular imbalance (but I do not recommend relying on it for a long period of time) or using sports tape to correct the tracking of the patella.
2. Avoid descending stairs – The eccentric load  on your knees makes patellofemoral pain syndrome worse. Stair climbing is beneficial, but avoiding going down the stairs will decrease the pressure on your knee.
3. Lose weight – My specialist told me that our knees take on a load 7x our body weight when we load then when we sit, stand or climb the stairs. Every bit of extra baggage you lose is 7x less stress on your injured knee.

Incidental problem solving

One of my big beliefs is to work on correcting the body’s problems at every chance. Especially when the problem is exacerbated by simple movements, its important to continue to work on strengthening VMO and releasing ITB daily. I have a few tricks that I used in my recovery and continue to use today
1. Hold maximal quadricep contractions during your day

• While the traffic light is red
• Until the elevator doors open
• While you’re stuck in traffic

2. Work on ITB throughout the day – An ITB stretch with lunch for example, or take a golf ball to work or in the car and work on ITB when you can.

The final word

Rehab and injury prevention is a perpetual struggle. VMO needs to be trained as an endurance muscle as well as for maximal strength. It needs to be able to activate for every minute you are walking, moving or climbing stairs. In order to prevent ongoing pain or worsening of the knee injury, you will need to commit to your recovery. It will be worth it, I promise.