The Pesky Patellofemoral Joint 

The annual prevalence of patellofemoral pain in the general population has been found to be over 22%! Anterior knee pain is not just a problem for young adults and adolescents. In this article, I’d like to provide you with several key tests you can use to help determine if you may have patellofemoral pain and then outline how a physical therapist can successfully help you recover.

Patellofemoral pain is largely a diagnosis of exclusion. There can be many causes of knee pain and it is important for your healthcare provider to properly assess your individual condition. Many individuals have anterior knee pain with prolonged sitting with flexed knees. Dr. Clinton from Evergreen Sports & Orthopedics adds, “with work/school from home there is increased sitting like I have yet to see in my career and with it comes some knee aggravation for both kids and adults. Add to that a quick return to activity multiple soccer teams and increased Pelotons it is a recipe for anterior knee pain.”

There are three common provocative diagnostic tests that are most closely correlated with patellofemoral joint pain:

• Squatting

• Climbing Stairs

• Eccentric Step-Down Test

Research has linked several key factors that may contribute to an individual developing patellofemoral pain. These factors are not present in everybody who has symptoms, but there are often impairments in one or more of these areas found during a physical therapy exam.

Factors OF Patellar Pain

• Sub-optimal biomechanics of knee alignment with loading

• Knee often moves medially when squatting—"Dynamic Valgus”

• Weakness in the hip muscles and core

• Excessive upright trunk posture with squatting

• Weakness of the entire quad, not just VMO

• Excessive mid-foot mobility and lack of control in weight bearing

Several Factors of concern given by Dr. Christopher Boone when asked are:

Carrying excess weight

• Being overweight is a surefire way to put added stress on your knees. When you’re overweight, each extra pound puts up to 3 pounds of added pressure on your knees when you walk. If you run, it more than triples.

• Skipping the gym

  • Exercise is a crucial component when it comes to maintaining healthy knees because it keeps your muscles, bones, and connective tissue strong. At the same time, you should avoid putting repetitive strain on your joints. To protect your knees, Dr. Boone recommends participating in daily forms of moderate exercise that build strength, stamina, and flexibility. Great low impact activities often include walking, biking, swimming, yoga, and strength training.

• Posture

  • Believe it or not, your mom was right about standing up straight. When it comes to your knees, it’s essential to have your muscles, ligaments, and joints properly aligned to avoid unnecessary strain.

• Wearing the wrong shoes

  • “Think those high heels or flip-flops are making a fashion statement? Wearing the wrong shoes can also put unwanted stress on your knee joints.” To ensure proper weight distribution throughout your body, focus on wearing high-quality shoes that support your feet during physical activity, and address any anatomical considerations. You can also get orthotic inserts to wear inside your shoes that address many issues and relieve pressure on your knees.

Dr. Jamie Antoine adds, “ there is also pain and tendon research that suggests that when there is chronic irritation or tendinosis it creates abnormalities by attracting blood vessels that also many times have nerve tissue that accompanying them. The nerves might hold some responsibility as well as inflammatory markers that are present in the area.”

The good news is that physical therapists are experts in diagnosing, treating, and educating patients with this condition. A PT is able to determine which of these factors may be causing your symptoms and they will develop a plan of care to help you return to the activities you enjoy. Focused exercise that targets strengthening of the core, hips, and thigh is the standard of care. The gains in strength must be integrated into newly-learned motor control strategies that optimize your biomechanics and reduce the stress to the front of the knee. A graded return to activity will be critical to your success to ensure that your strength gains and movement patterns progress in unison as you increase your loading. By applying what you learn while working with a physical therapist, you will have many of the tools to successfully reduce or eliminate patellofemoral pain while enjoying activities that you love!

AUTHOR:

Mark Bouma   DPT, OCS, COMT, CSCS, FAAOMPT, CFI

CONTRIBUTORS:

Dr. Camile Clinton, MD
Orthopedic Surgeon
Dr. Christopher Boone, MD
Orthopedic Surgeon
Dr. Jamie Antoine, MD
Orthopedic Surgeon, MD
Ben Wobker, PT, MSPT, CSCS, CFSC, SFMA