At Active Step, Patellofemoral joint pain is the most common cause of knee pain that we get presented with. This joint pain accounts for around 25% of all the knee cases that we see.
The patellar is more commonly referred to as the “kneecap” and the femur is the “thigh bone”. The point at which the knee cap and thigh bone join together is called the patellofemoral joint and this is where the condition manifests.
What is it?
PFJP most commonly affects women and young adults. It is also referred to as “runner’s knee” or “jumper’s knee”, as it generally affects individuals who participate in sport. The types of patients we see are usually adolescent netball players, cross country runners and footballers that engage in sport several times a week!
Your knee cap normally glides up and down through a channel in the thigh bone called the “femoral groove”. As you bend your knee the pressure between the kneecap and the groove increases. If the kneecap doesn’t track properly through the groove it can lead to rubbing against the thigh bone which can causes patellofemoral joint pain.
Typically sufferers will describe pain and stiffness in the front of the knee and around the kneecap. Reporting difficulty climbing stairs, kneeling, squatting, hopping or running.
In severe cases of patellofemoral joint pain a concurrent condition called Chondromalacia patella may be present. This occurs as a result of softening and breakdown of the articular cartilage on the underside of the kneecap.
The two most common reasons for kneecap misalignment which leads to irritation in the patellofemoral joint are:
- Muscular weakness and imbalance mainly in the quadriceps (thigh muscles) and gluteal muscles (bottom muscles). Muscle tightness around the hips and thighs can also contribute to a maltracking knee cap.
- Biomechanical issues which may stem from poor foot posture e.g. flat feet or twisting in the hips and pelvis.
How is it diagnosed?
At Active Step, our Musculoskeletal Podiatrists conduct a thorough assessment of the hips, buttocks, thighs and lower leg. This helps to identify any muscular weaknesses, asymmetries between the limbs and biomechanical issues stemming from the feet and ankle. They will also review current footwear and give advice on the most appropriate type of footwear required for the activities that are being engaged in.
Our Podiatrists also provide expert Video Gait Assessment using OPTOGAIT, to determine any suboptimal movement patterns and imbalances that may be affecting knee function during walking and running.
This holistic approach enables our Podiatrists to produce a targeted treatment plan to ensure that all the contributing factors of the patellofemoral pain are managed in the most effective way.
How is it treated?
A typical treatment approach that our Podiatrists may include the following;
Initially a period of REST, ICE, ANTI INFLAMMATORIES and ACTIVITY MODIFICATION.
Once the patient’s symptoms have settled a progressive course of physical therapy targeting any strength and flexibility issues in the thigh muscles and buttocks is provided. This is alongside addressing any biomechanical issues arising from the feet, hips or pelvis.
It is not uncommon for our Podiatrists to supply prescription foot orthoses along with their exercise rehabilitation. Research has shown them to be effective in reducing symptoms of PFJP. These specialist insoles may be used in the short term until pain has resolved. A custom orthotic solution may be prescribed in more complex cases that require long term management. Our Podiatrists may also employ knee taping techniques which can be very effective in reducing symptoms and during return to activity.
Overall, 90% of sufferers who commence this type of rehabilitation will be relatively pain free within 6 weeks. In the few cases that do not respond to conservative treatment our Podiatrists will refer onwards to our Consultant partner for an opinion. They will assess whether surgical intervention may be necessary to repair any damaged structures in the knee.