Patellofemoral Syndrome (anterior knee pain, runners knee) - for Patellar Tendinopathy information, see bottom of page
What is it?
Patellofemoral syndrome refers to pain arising from the joint between the kneecap and the underlying thigh bone. Other names for this condition include Patellofemoral pain syndrome, chondromalacia and runners knee.
How does it happen?
Patellofemoral syndrome most often results from overuse of the knee. When the knee is bent and straightened, the kneecap (patella) slides up and down within a groove on the end of the thigh bone (femur). With repeated bending and straightening, such as during activities involving walking, running, jumping and cycling, the underneath surface of the kneecap can become irritated. This can result in pain and occasionally swelling.
How does it feel?
The main sensation associated with patellofemoral syndrome is pain. This is felt behind and around the kneecap. Patellofemoral syndrome is commonly aggravated by walking, running, going downstairs or sitting for a prolonged period with a bent knee. Associated with this pain may be grinding noises heard when the knee is bent or straightened, a sensation of the knee giving way and weakness in the knee. The knee may also swell at times.
What should you do?
Patellofemoral syndrome frequently does not get better on its own if the cause is not addressed and you continue your activity or sport. If you have or suspect patellofemoral syndrome, you should consult your nearest Sports & Exercise Physiotherapist. In the meantime, you should avoid any activities which aggravate or cause your knee pain to occur. Icing the front of your knee will be of benefit. Ice should be applied to the injured area for 15-20 minutes every 1-2 hours. Ideally, it should be applied using crushed ice wrapped in a moist cloth or towel.
What shouldn’t you do?
If you have or suspect you have patellofemoral syndrome, you shouldn’t ignore the problem. This may lead to your problem getting worse such that your pain becomes more severe and is felt more frequently.
Could there be any long-term effects?
Patellofemoral syndrome does not usually produce any long-term effects, as long as it is appropriately diagnosed and treated. Recovery usually takes place in a number of weeks. During this period you can often keep participating. In some situations recovery may be prolonged due to underlying biomechanical deficits or joint irritation.
Management
The assistance of a Sports & Exercise physiotherapist is important in the treatment of Patellofemoral syndrome. Initially, they can assist in diagnosing the problem and the severity of the condition. From this, the Sports & Exercise Physiotherapist will be able to determine an appropriate treatment plan. This may involve initial activity modification, the taking of anti-inflammatory medications, soft tissue treatment such as massage and stretching, taping or bracing of the kneecap and specific knee strengthening exercises to improve kneecap movement (tracking). The Sports & Exercise Physiotherapist will also be able to assess and determine why you developed patellofemoral syndrome and address this during your recovery to prevent a re-occurrence when you return to exercise and sport.
Patellar tendinopathy (jumper’s knee)
What is it?
Often referred to as ‘jumpers’ knee’, patellar tendinopathy refers to inflammation within the tendon which lies just below the knee-cap (patella).
How does it happen?
Patellar tendinopathy is a common injury in sports predominantly involving jumping and landing, and results from overuse of the patellar tendon. The function of the patellar tendon is to transmit force produced by the large thigh muscle (quadriceps) to the shin and bone (tibia) to produce movement of the knee joint. Repetitive use of the quadriceps muscle and, therefore, the patellar tendon can lead to microscopic tears or stress within the substance of the tendon. Gradual degeneration of the tendon may occur as a result. Factors which may contribute to patellar tendinopathy include a recent change in training (including frequency, duration, intensity, training surfaces), reduced rest times, biomechanical abnormalities, and decreases in muscle flexibility. These factors can lead to increased stress on the patellar tendon, microtears and subsequent tendinopathy.
How does it feel?
Patellar tendinopathy results in pain felt just below the kneecap. The pain may be aggravated by activities such as jumping, hopping and bounding and typically develops gradually. Initially, the tendon may only be painful following exercise. Associated with the pain may be stiffness or tightness in the region of the kneecap. Typically, these initial signs of patellar tendinopathy are ignored as they disappear quickly with walking about or applying heat (i.e. a hot shower) over the knee cap region. However, as you continue to exercise, the tendinopathy progresses and the pain within the tendon becomes more intense and more frequent. In the earlier stages, this pain during exercise may initially disappear as you warm up, only to return when you cool down. However, as you continue to exercise the tendinopathy worsens and your pain may begin to be present for longer periods during exercise until it is present all of the time. This may interfere with your performance.
What should you do?
Patellar tendinopathy generally does not get better on its own if the cause is not addressed and you continue to exercise. If you have or suspect you have patellar tendinopathy, you should consult your nearest sports medicine professional. In the meantime, you can begin initial treatment. This should consist of icing following exercise and deloading by modifying your jumping, hopping or running. Icing should consist of crushed ice wrapped in a moist towel applied just below the kneecap until the skin is numb.
What shouldn’t you do?
If you have or suspect you have patella tendinopathy you shouldn’t ignore the problem. Your pain may get better as you exercise, however, the exercise you are doing may interfere with the healing process and be causing further damage. This can lead to your injury getting worse such that your pain does not ‘warm up’ and you feel it throughout exercise. If this occurs, your recovery may be prolonged and it may take a number of months for you to return to your activity or sport.
Could there be any long-term effects?
Patellar tendinopathy does not produce any long-term effects, as long as it is properly diagnosed and appropriately treated. If not, it can lead to prolonged pain in the region just below the kneecap and a prolonged lay-off from exercise and sport.
Management
The assistance of a Sports and Exercise Physiotherapist is important in the treatment of patellar tendinopathy. Initially, they can assist in diagnosing the problem and its severity. Then your Sports and Exercise Physiotherapist will be able to determine an appropriate treatment plan. This may involve activity modification, soft tissue treatment such as massage and the progression through a series of specific strengthening exercises. The Sports Physiotherapist will also be able to assess and determine why you developed patellar tendinopathy and address this during your recovery to prevent a re-occurrence when you return to full activity.
Brukner & Khan (2012) Clinical Sports Medicine.
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