Best Patellofemoral Pain Syndrome Treatment In Delhi NCR.

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What is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome (PFPS) is pain at the patellofemoral joint. This joint is the contact point between the knee cap (patella) and the upper leg bone (femur). The knee cap (patella) is imbedded into the quadricep muscle, which will be important to remember when we talk about the cause of pain.Patellofemoral Pain Syndrome (PFPS) results from the patella (kneecap) rubbing on the femur bone underneath. It may also be known as Runner’s knee, Chondromalacia patellae, anterior knee pain, and Patellofemoral joint syndrome.

What causes Patellofemoral Pain Syndrome?
  • When you bend or straighten your knees, the kneecap moves up and down in a groove that’s located in your femur or thigh bone. When the muscles in your buttocks and thighs are weak or stiff, this movement takes more effort. Over time, you may develop knee pain every time you bend or straighten your knees because the kneecaps aren’t properly tracking in the groove.
  • If you don’t have the condition treated in a timely manner, your knee pain increases, and you may be doing more damage to the joint. While there are many factors that influence whether you develop patellofemoral pain syndrome, some of the more common ways you can end up with damaged knees include:
  • Overuse-Running, squatting, climbing stairs, and jumping are activities that put repeated stress on your knees. When you overdo exercises like increasing the sets, running longer distances or running more often in a week, you increase the repetitive stress, which in time can create ideal conditions for patellofemoral pain syndrome.
  • Trauma-If you’re in a car accident, have a bad fall, or get a direct hit on your knees, the force of the blow may cause fractures or dislocation of your kneecap.
  • Previous surgery for an ACL tear. This type of surgery requires grafting a patellar tendon, which can increase your risk for patellofemoral pain.
  • Muscle or tendon tightness-If you have tight hamstrings or a rigid Achilles tendon, you may experience knee pain.
  • Rheumatoid arthritis- This type of arthritis causes stiffness and pain in your knee joints.
  • Improper form-If you don’t use the equipment in your gym correctly, you can end up with knee pain and other physical damage.
  • Inappropriate footwear- Not wearing the type of footwear that provides adequate shock absorption can damage your knees.
  • Choosing rough terrain-Running or jogging over uneven ground presents the possibility of a knee or ankle injury.
Mechanics

Looking at the feet, pronation and/or flat feet rotate the lower (tibia/fibula) and upper (femur) leg inwards. When they rotate in, the knee cap (patella) also rotates in, causing the joint to be in the improper position. Contributing to the misalignment are the quadricep muscles (on the front of the thigh). The quadriceps contain a group of four muscles. Three of these muscles are pulling the knee cap (patella) slightly outside, where only one is opposing these muscles and pulling in. When the foot rolls in (pronation/flat feet), rotating the lower and upper legs in, the three muscles on the outside are at an advantage and pulling even harder on the knee cap.

Muscle Imbalances

  • Muscle imbalances can originate from foot pronation/flat feet, or can be from other causes. If the inner quadricep muscle is too weak, the outer quadricep muscles will pull at the knee cap (patella) causing improper tracking at the joint.

  • This can be caused and/or exaggerated from bad form. Squatting with the knees pointing inwards will strengthen the outside muscles and almost ignore the inside muscle. This improper squatting can begin from foot pronation, or from another cause.

  • Poor Leg Posture, this is much like having bad wheel alignment on a car causing uneven wear on the tyres. The most common presentation is a “knock kneed” posture. This is often due to flat feet, weak gluteal muscles and/or poor muscle control.

Patellofemoral Pain Syndrome Symptoms

Symptoms include an aching pain in the knee joint, particularly at the front of the knee and under the patella.

  • There is often tenderness along the inside border of your kneecap.
  • Pain around the kneecap
  • Aggravation of symptoms with prolonged sitting, kneeling or squatting
  • Aggravation of symptoms ascending/descending stairs
  • Aggravation of symptoms with hopping or running
  • Swelling will sometimes occur after exercise.
  • Patellofemoral pain is often worse when walking up and down hills or sitting for long periods of time.
  • You may notice a clicking or cracking sound when bending your knee.
  • Your quadriceps muscles on the painful leg may appear reduced in size, especially the vastus medialis oblique on the inside of your knee.
Assessment Tests
  • A therapist will use a number of tests to identify what might be causing your pain and rule out other conditions which may have similar symptoms
  • They may measure the ‘Q angle of your knee‘. This is the angle between the quadriceps muscles and the patella tendon and provides useful information about the alignment of the knee joint.
  • Other tests include:
    • The apprehension test
    • Patella compression test
    • Patella grind test
    • Patella glide test

Typical assessment findings:

  • Inflammation around the knee
  • Reduced mobility of the patella
  • Tight lateral knee structures (iliotibial band and gluteals)
  • Over pronation (rolling in) of the mid foot
  • Weakness of the quadriceps and gluteal muscles
  • Reduced strength and tightness of the calf muscles
Clinical Features
  • Onset: Insidious onset of an ill-defined ache localized to the anterior knee, behind the kneecap. Can be gradual or acute, possibly triggered by trauma.
  • Location: Pain is often poorly localized under or around the patella.
  • Quality of Pain: Usually described as “achy,” but may be “sharp.”
  • Exacerbating Factors:
    • Worsens with squatting, running, prolonged sitting, or ascending/descending stairs.
    • Particularly aggravated by hills.
  • Occurrence: Pain may occur in one or both knees.
  • Instability:
    • The affected knee may feel like it’s “giving way” or “buckling.”
    • In patellar instability, there may be a sensation of patellar slippage or bony subluxation, especially with twisting, cutting, or pivoting.
  • Swelling: Occasional mild swelling may occur, but a gross effusion is rare (unlike traumatic knee injuries).
  • Variability: Pain may vary throughout a run.
Risk Factors
  • Activities (running, climbing up & down stairs, and squatting).
  • Dynamic valgus (increases patellar mal-tracking).
  • Female sex.
  • Foot abnormalities (rearfoot eversion & pes pronatus).
  • Overuse or sudden increase in physical activity level.
  • Patellar instability.
  • Quadriceps weakness.
  • Anatomic (increased femoral anteversion, patella alta, trochlear dysplasia, excessive foot pronation).
  • Biomechanically (muscle tightness or weakness, joint laxity, gait abnormality).
Treatment

Ineffective Physical Agents:

Systematic reviews and RCTs have demonstrated a lack of evidence supporting the use of physical agents such as:

  • Therapeutic Ultrasound
  • Phonophoresis
  • Iontophoresis
  • Transcutaneous Electrical Nerve Stimulation (TENS)
  • Medium Frequency Neuromuscular Electrical Stimulation
  • Low-Level Laser Therapy
  • Extracorporeal Shock-Wave Therapy
  • Electromyographic Biofeedback
  • Massage Therapies

Strengthening Exercises:

Strengthening exercises have shown positive results, particularly:

  • Dynamic Knee Extension
  • Squats
  • Stationary Cycling
  • Static and Dynamic Quadriceps Exercises
  • Active Straight Leg Raise
  • Leg Press
  • Step Up and Down Exercises
  • Hip Strengthening: Hip exercises (3 sets of 10-15 reps) are also recommended. For athletes involved in demanding sports like running and jumping, consider higher repetition sets (3 sets of 20-30 reps).

Stretching:

Targeted stretching is crucial. Key areas to address include:

  • Hamstrings
  • Quadriceps
  • Iliopsoas
  • Gastrocnemius
  • Iliotibial (IT) Band

Specific Stretches:

  • Tight Hamstrings: Passive Straight Leg Raise (SLR) stretches, holding each repetition for 15-20 seconds.
  • Tight Hip Flexors: Passive modified lunge stretches and active prone leg lift with knee bent (10 reps; 30 seconds each).
  • Tight IT Band: Standing stretches in three positions: upright, overhead clasped hands, and diagonally lowered arms.
  • Tight Gastrocnemius: Static stretching in a forward lunge position.

Taping:

Kinesio taping, particularly the McConnel technique, is a popular treatment. The aim is to correct lateral patellar maltracking and patellar tilt. This technique can be used during training and competition.

Patellar Braces:

Patellar braces apply an external, medially directed force to counteract lateral patellar maltracking. Biomechanical studies suggest they can alter patellar tracking.

Soft Tissue Manipulation:

Soft tissue manipulation corrects fascial thickening and shortening.

  • Direct Technique: Fascia is manipulated using knuckles, elbows, ulnar border of the hands, or a fist.
  • Indirect Technique: Using a foam roller on tight muscles. A vertical release proximal to the attachment of the muscle belly or fascia can be applied.

Multimodal Approach:

A multimodal approach is highly recommended for reducing pain in athletes with PFPS in the short and medium term. This involves a combined program of:

  • Strength training of weak muscles
  • Stretching of tight muscles
  • Adjunctive therapies (taping, bracing, foot orthotics, if applicable)

Return to Sports Criteria:

An athlete can return to sport when the following criteria are met:

  • No swelling.
  • No pain in squatting and in descending/ascending stairs.
  • Good quadriceps strength (especially VMO – vastus medialis oblique).
  • Proper hamstring, IT band, and calf flexibility.
  • Normal gait biomechanics.
  • Proper core stability strength.
  • Good performance in challenging functional tests (vertical jumping, anteromedial lunge, step down, single leg press, balance and reach test).

Plyometric Exercises:

Plyometric exercises increase muscle power and bridge the gap between traditional rehabilitation and sport-specific activities. Start at low intensity and gradually progress to high intensity, performing the exercises three times per week. Training programs generally range from 6 to 15 weeks.

  • Plyometric Exercise Examples:
    • Jump in place
    • Box jump
    • Explosive step-up
    • Splits squats
    • Squats jump
    • Single linear jumps
    • Multiple linear jumps
    • Plyo-jacks
    • Tuck jump
    • Ins and out
    • Snowboard hops
    • Skaters’ hops
    • Burpees
    • Jumping spider
    • Bounding (forward, backward, & lateral)
    • Depth jumps
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