Patellofemoral (kneecap) Pain – The solution

Patellofemoral pain syndrome (PFPS) is a very common issue which we successfully deal with here at the Twyford Clinic. There are many reasons this can occur in both an athlete, non athlete and in growing children.

The pain felt commonly affects the posterior (back) aspect of the patella (kneecap). We expertly assess if there is some Mal alignment, this occurs when the patella does not track well in the trochlear groove this is a gap in the end of the femur as shown.



If the patella moves medially or more commonly lateral (out to the side) the back of the patella can rub on the groove sides, this inflames the articular cartilage and can cause swelling and pain, Crepitus – a crunching noise and instability. A common problem is the Vastus medialis oblique is not firing efficiently – this is the muscle lower in the quads medial side. Other muscles also contribute – the vastus lateral commonly has trigger points which make it tighten up and pull the patella laterally. Also if the quads or hamstrings are tight they will alter the biomechanics going through the knee and alter its movement.

Overuse is often cited as being a problem, however there are many athletes who 100 miles these days and don’t suffer withPFPS, so it is more likely to be an imbalance rather than just overuse, though overuse can be cause if you have’t trained for an activity properly.

Females have been shown in clinical studies to suffer more PFPS problems, possibly due to an increased Q angle (knock knees) position which is natural in females, though again commonly the issues we see are due to imbalances rather than gender.

Control of the gluteal muscles is also a major factor in PFPS. The Gluteus medium helps control the amount of rotation in the leg on step through and if this is weak the knee can bend/ buckle in on each step stressing the knee and flattening the foot. The Gluteus maximus is important to fire well to help with hip extension and pushing off when walking or running. We often see very poor recruitment of the gluts, then the hamstrings have to work harder and may tighten up and reduce the range in the knee therefore again stressing the patellofemoral joint.

The hips range of motion I also important as if there is a reduction in range at the hip the movement of the knee will be altered, this can be caused by osteoarthritis in the hip or for control as explained in the gluts paragraph, also congenital issues such as dysplasia can affect you later in life resulting gin knee pain.

The ankle/ foot complex is very important as it controls the leg from the ground up, if the foot overpronates or is blocked in range eg. The ankle joint is very commonly stiff post fracture, the big toe may have osteoarthritis and not allow movement so that is transferred up the leg to the ankle and knee.

As you can see there are many reasons why PFPS can be caused. We will provide you with a full biomechanical assessment to determine which is the cause to your issues and utilising the most up to date and expert treatment techniques cure your patella pain. We also provide orthotics to help control the foot position when indicated.


The Twyford Clinic Physiotherapy Knee Injuries

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