Patellofermoral Syndrome

Patellofemoral Syndrome, also known as Chondromalacia Patellae, is a condition that affects the patellofemoral joint, leading to knee pain and functional limitations. Studies have shown that certain types of athletes are more susceptible to developing Patellofemoral Syndrome. Individuals involved in high-impact sports that involve repetitive knee movements, such as running, jumping, and squatting, are at a higher risk. This includes athletes participating in sports like basketball, soccer, volleyball, and track and field. The constant stress and strain placed on the patellofemoral joint during these activities can contribute to the slow degeneration of cartilage of the patella and femoral groove.

Certain factors can increase an athlete’s vulnerability to Patellofemoral Syndrome. Female athletes, in particular, have a higher incidence of the condition due to anatomical and biomechanical differences. The wider pelvis in females can alter the alignment of the patella, leading to increased stress on the joint. Hormonal fluctuations during the menstrual cycle may also influence the stability of the patellofemoral joint.​

Symptoms:

Patellofemoral Syndrome is characterized by various symptoms that can significantly impact an athlete’s performance. The primary indicators include anterior knee pain, which athletes may experience as a dull, aching pain around or behind the kneecap (patella). This pain worsens during activities like running, jumping, or squatting. Athletes with Patellofemoral Syndrome may also experience discomfort when sitting for extended periods or while descending stairs. Additionally, mild to moderate swelling, localized tenderness, and a grating or cracking sensation (crepitus) during knee movement may be present.

Anatomy:

To visualize the movement of the patella on the femur in the model above, use the 🔍 button to search for patella. Follow the drop-down menus to isolate the patella.

The patellofemoral joint is formed by the articulation between the patella (kneecap) and the femur (thighbone). The patella acts as a fulcrum, facilitating the transmission of forces from the quadriceps muscles to the lower leg during movements such as running, jumping, and squatting.

In a healthy patellofemoral joint, the patella glides smoothly within the femoral groove during knee flexion and extension. However, in individuals with Patellofemoral Syndrome, this smooth gliding motion is disrupted, leading to various structural and biomechanical implications.

One of the key implications is abnormal patellar tracking. Patellar tracking refers to the movement and alignment of the patella within the femoral groove. Muscle imbalances, such as weakness or tightness in the quadriceps or hip muscles, can alter the direction and position of the patella, causing it to deviate from its optimal path. This abnormal tracking places excessive stress on the patellofemoral joint, leading to irritation and damage to the articular cartilage on the back surface of the patella.

Another implication is increased pressure and shear forces on the patellofemoral joint. When the patella does not track properly, it can result in concentrated pressure on specific areas of the joint, particularly the cartilage. Over time, this increased pressure and shear forces can lead to the breakdown and softening of the cartilage, a condition known as chondromalacia. The damaged cartilage becomes more susceptible to inflammation, pain, and further degeneration.

Furthermore, biomechanical abnormalities can contribute to the development of Patellofemoral Syndrome. For instance, individuals with flat feet or other foot alignment issues may experience altered forces transmitted through the lower limb, affecting the patellar tracking and increasing stress on the patellofemoral joint. Similarly, structural variations in the lower limb, such as misalignment of the hip, knee, or ankle, can also impact the mechanics of the patellofemoral joint and contribute to the onset or progression of the syndrome.

Causes:

The development of Patellofemoral Syndrome can arise from a combination of intrinsic and extrinsic factors frequently observed in athletes. Muscle imbalances, such as weakness or imbalances in the quadriceps, hamstrings, and hip muscles, can alter the alignment and tracking of the patella, leading to increased stress on the joint. Overuse and repetitive stress, often seen in activities like running or jumping, can also contribute to the condition. Biomechanical abnormalities, including flat feet, abnormal patellar tracking, or misalignment of the lower limb, are additional causes. Furthermore, direct trauma or injury to the knee joint can damage the articular cartilage, resulting in knee pain and dysfunction.

At Latitude Physiotherapy, we employ evidence-based rehabilitation strategies tailored to the unique needs of every athlete we encounter. Our comprehensive approach focuses on several components. We start with pain management and inflammation reduction, utilizing manual therapy techniques such as soft tissue mobilization, joint mobilization, and myofascial release to alleviate pain and restore tissue flexibility. Modalities like ice or heat therapy, and electrical stimulation may also be employed to reduce pain, swelling, and inflammation.

To address muscle imbalances, we design strengthening and flexibility exercises that target the quadriceps and hip muscles. These exercises enhance strength, endurance, and optimize patellar alignment, effectively addressing any imbalances. Core stability and balance training are also incorporated to improve overall body control and reduce excessive stress on the knee joint.

Our rehabilitation approach also includes biomechanical assessment and correction. Gait analysis allows our therapists to identify any abnormal walking or running patterns contributing to the condition. If necessary, temporary orthotic devices such as shoe inserts or braces may be recommended to correct foot alignment and provide additional support to the knee joint.

Throughout the rehabilitation process, we emphasize activity modification and a gradual return to sports. We provide guidance on modifying activities or training techniques to reduce excessive stress on the knee joint during the rehabilitation phase. Working closely with each individual, we develop a progressive return-to-sport program, ensuring a safe and successful transition back to athletics.

Patellofemoral Syndrome can be a significant hurdle for athletes, hindering their performance and enjoyment of sports. At Latitude Physiotherapy, we are committed to providing athletes the highest quality of care. By addressing the symptoms, underlying causes, and employing effective strategies, we empower athletes to regain their optimal function and strength.