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PFPS- Knee pain: Cause and solution!

If you notice a gradual dull aching sensation in the knee with intermittent sharp pain especially with negotiating stairs, along with crepitus in the knee when you bend and straighten the knee, you may be suffering from Patella Femoral Pain Syndrome (PFPS).

PFPS which used to be known as Chondro-Malacia Patella (CMP) , Anterior Knee Pain and Runners’ Knee are all very similar conditions. These conditions and symptoms can occur due to a varying degree of wear and tear (degeneration) of the cartilage behind the knee cap, also known as the patella femoral joint.

What are the main contributing factors?

Three main factors attributed to cause increased degeneration of this cartilage are:

1. Muscle tightness:

The quadricep muscles and the Ilio Tibial Band (ITB) tend to be tight in people with PFPS. If the quadricep muscles are tight, it has a tendency to pull the knee cap much closer to the thigh bone. This increase in pressure leads to grinding of the knee cap against the thigh bone causing the degeneration of cartilage.

The ITB has attachments to the outer side of the knee cap via a connective tissue known as the lateral retinaculum. The knee cap tends to sit comfortably in a congruent position within the thigh bone. However when the ITB is tight it pulls the knee cap in an outward direction shifting the knee cap away from, and out of its natural groove.

This slight shift or tilt increases the pressure or loading behind the knee cap leading to degeneration of cartilage and pain.

2. Muscle Strength:

Imagine jumping and landing on a straight knee compared to a bent knee. There is definitely more impact that goes through the knee in the first instance because your muscles are not helping to absorb the impact whereas a bent knee allows the muscles to contract and dampen the impact on the joint.

Similarly if the quadriceps, are not strong enough, your knee joints takes the slack with every step that you walk, run, or stairs that you climb.

The knee joint in this situation will be grinding excessively as muscles are not effectively stabilising the joint and supporting a person’s body weight.

3. Biomechanical faults:

Flat feet (poor arches), knocked knees, knee cap position (rotation/ tilt) and increased Q angle are all factors that result in an imbalance of muscles around the knee joint and mal-alignment of the knee cap, that may accelerate the degeneration of the cartilage in the patellafemoral joint.

So what can you do to solve your knee pain?

Treatment for PFPS would entail stretching exercises for the quadricep muscles and ITB and strengthening exercises for the muscles around the knee joint in particular the quadriceps. In addition getting appropriate footwear to support the arches of your feet or considering customised orthotics to correct your biomechanical faults would also be strongly recommended. If your keen athlete, or struggling with pain, you may even want to consider a knee support for symptoms reduction and control.