Patellofemoral Syndrome

Patellofemoral Syndrome (PFS) is a group of conditions in which the main indicator is pain under or surrounding the patella. The syndrome can be caused by many different problems that arise at the patellofemoral joint. As the knee flexes and extends, the patella tracks along the intercondylar groove of the femur. Any factor that disrupts the normal tracking (direction of travel) of the patella can result in inflammation or pain on the undersurface of the patella. This may include inflammation, damaged cartilage, and the development of arthritis. Cases where patella tracking is especially poor can even result in subluxation or dislocation of the patella.

Patellofemoral syndrome can also be a “catch all term” or synonym for a variety of other disorders. Other disorders which fit in this category include: Anterior knee pain syndrome and over-utilization syndrome. PFS has a variety of signs and symptoms associated with it. Usually onset is gradual and with pain on the anterior portion of the knee around the patella with women affected more than men. Often stiffness occurs in the morning or with prolonged sitting. Activities such as bicycling, running, or ascending/descending stairs commonly causes pain around or under the knee cap. Swelling around the patella, instability, pseudo-locking, and dislocation can also occur.

Patellofemoral syndrome can be challenging for the medical professional to diagnose. Often on x-ray or physical examination there are no abnormalities noted unless swelling is present in with severe cases. Usually there will be tenderness of the medial facets of the undersurface of the patella. Differential diagnoses is used by physical therapists to eliminate other possibilities or diagnoses from being the cause of the problem and establishing a definitive diagnosis of PFS. Essentially this occurs on the first day of treatment during the evaluation process by a skilled physical therapist.

The etiology and risk factors associated with patellofemoral syndrome syndrome are patients with “knock knees” genu valgum and “flat feet” pes planus. Other structural abnormalities can also place additional stress on the knee. Excessive internal rotation of the hips and and a Q-angle greater than 19 degrees also predisposes an individual to develop patellofemoral syndrome. A shallow patella groove and flattened femoral condyle are other contributing factors. Increasing your current exercise regimen or beginning a new program often causes pain if the individual has PFS, especially when coupled with muscle imbalance with the lateral quad dominating the medial quadriceps muscle (VMO) causing abnormal patella tracking.

Physical therapists can help a patient eliminate knee pain and return to normal living pain free in most cases. The process begins with the first appointment when a comprehensive evaluation occurs to establish a diagnosis. After this the individual will be scheduled for sessions with the therapist to obtain education about the disorder and it’s prognosis as well as receive a variety of treatments over time to eliminate pain and return to normal function.

If you think you or someone you know have a similar disorder feel free to contact the therapists at the Institute of Physical Therapy in Lewiston and schedule an examination.

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