Have you started to notice an aching sensation or pain to your knee(s) for unknown reasons? Are you starting to notice that you are having knee pain when you walk or run, or with just regular daily activities such walking, getting up from a seated position, or going up and down stairs? Has the pain, which you originally thought would GO AWAY ON ITS OWN, started to get worse with time. You, like many others are experiencing the most common form of knee pain. Patellofemoral Pain Syndrome (PFPS) is the most common form of knee pain, with most of the pain located around and underneath the kneecap.
Patellofemoral Pain Syndrome is a common knee problem, with most of the pain located in the front of the knee, but more specifically behind/underneath the kneecap. Pain usually worsens with climbing stairs or hills, running, squatting, and sitting for prolonged periods of time with knee bent. Pain is usually alleviated with reduction of strenuous activity, frequently getting up from sitting position, and using unaffected leg to lead with going up and down stairs. People may ice and take over the counter medication. Some people experience relief of symptoms with rest, modification of activity (then slowly resuming activities/exercise), and OTC medication. For others, the condition worsens, requiring them to see a healthcare professional such as an orthopedic surgeon and a physical therapist.
In the past, most physicians and physical therapist would work on the knee and muscle around the knee to treat PFPS, which was not very effective. Physician would routinely prescribe quad strengthening and stretching to the quads and hamstrings, with minimal long-term improvements. The reason for this is that that did not address the main issue, ABNORMAL PATELLA TRACKING/MOVEMENT. The knee moves up and down when a person bends and straightens the knee. In a normal, pain-free knee, the kneecap moves in the trochlear groove. This allows for smooth translation of the kneecap and the femur. When the kneecap tracks medial, but more commonly laterally, you have abnormal contact of the undersurface of the kneecap with the lateral femoral condyle of the femur. It this persists over time, then there could be irritation to the tissue and bone causing pain the knee. Over time, physical therapist have realized that there are many other factors that cause PFPS. The knee can be considered a DUMMY JOINT. It is affected by position of the hips and pelvis, and the lower leg and foot and ankle. Over time, physical therapist have realized that addressing the hip/pelvis region, and the foot and ankle, cans significantly help with PFPS.
Some things that need to be assessed and addressed by the physical therapist are:
- Tightness to hip and buttocks muscles
- Pelvis and hip positioning
- Weakness to low back, hip, buttocks muscles
- Flat Feet (pes planus)
- High Arches (pes cavus)
- Weakness to the lower leg and foot and ankle muscles
Physical Therapy Treatments will consist of:
- A thorough assessment of the knee, hip/pelvis, low back, and foot/ankle regions.
- Flexibility exercises to address tightness to low back, hip/pelvis, thigh, lower leg, and foot and ankle
- Strengthening exercises to address weakness to the same area as stated above.
- Manual Therapy techniques to address joint stiffness, muscle tightness and soft tissue restrictions.
- Neuromuscular Re-education activities which will focus on activities, such as stairs, walking, sit<->stand, and squatting with emphasis on normal patella tracking.
The good news is that the above-mentioned physical therapy treatments have had good, long term results for decreasing knee pain, and allowing the patient to return to their prior level of function and recreational activities pain-free. If you are suffering from knee pain that is preventing you from doing your normal daily activities, or recreational activities, please contact Optimum Physical Therapy and Wellness to schedule a Discovery Session with one of our licensed physical therapists.