Kelli Miller, PT, DPT, CKTP
Pain in the front of the knee is a common complaint in adolescent and young adult athletes, especially in females. This pain is the most common symptom in patellofemoral pain syndrome, one of the most prevalent knee disorders. Pain is associated with activities that load the patellofemoral joint, such as squatting, ascending and descending stairs, walking, running, and jumping. Physical activities are often limited due to pain. Swelling, and snapping, popping, or grinding in the knee are also common symptoms.
What causes Patellofemoral Pain Syndrome (PPFS)?
The knee cap (patella) is attached to muscles in the thigh above it and the shin bone below it. When you bend and straighten your knee, the patella glides in a groove at the end of your thigh bone (femur). With patellofemoral dysfunction, the patella glides incorrectly outside of the groove, causing pain in the front of your knee. This maltracking can be caused by multiple factors. Some of the more common components are weak hip muscles, weak core (stomach and back) muscles, weak thigh muscles, tight muscles in the hip and thigh, muscle imbalances, and flat or pronated feet.
When your hip and core muscles are weak, they are unable to stabilize the pelvis, allowing the thighs to move in toward each other. This inward angle, along with tight muscles on the outside of your thigh, causes the patella to be pulled outside of the femoral groove. Repetitive poor tracking causes irritation on the underside of the patella and pain at the front of the knee. Flat feet and muscles imbalances can also contribute to improper alignment of your legs, causing the patella to track improperly.
If left untreated, this pain can continue to get worse, causing limited or inability to participate in sports. While patellofemoral dysfunction does not cause anterior cruciate ligament (ACL) tears, if the underlying hip weakness and impaired alignment are not addressed, you may be at increased risk for tears. If an athlete or child is complaining of knee pain, it is important to recommend seeing a doctor and getting a referral for physical therapy.
What should I expect at Physical Therapy?
PFPS is a common diagnosis seen in physical therapy. The first visit with a physical therapist (PT) will be an evaluation. During the evaluation, the PT will assess your posture and alignment, core, hip, knee, and ankle strength, range of motion, flexibility, and movement patterns, including how you walk, jump, and perform sport-specific activities. Based on these assessments, we will determine a specialized plan of care for you.
Future appointments will be based on the results of the evaluation. The PT will perform soft tissue mobilization and stretching techniques to muscles that were determined tight. You will be instructed in exercises to strengthen weak muscles and equalize imbalances. Ice, heat, electrical stimulation, ultrasound and other modalities used to decrease pain level and swelling may also be utilized during physical therapy sessions. The combination of these therapeutic techniques will allow the patella to glide easier in the proper groove.
As you progress in therapy, balance and proprioceptive activities, as well as plyometric work with a focus on proper biomechanics, will be added to your sessions. These will be directed at your specific sport or activity needs and will help you return healthy and strong!
Another important component of physical therapy is education and a home exercise program (HEP). You will be educated on the diagnosis and ways to treat symptoms when they occur at home (i.e. icing, elevation, stretching). You will be given a list of exercises to perform at home to compliment what is being done during your physical therapy sessions and proper warm-up and cool-down stretches to prevent future injury when you are ready to return to your sport!
The PT can also evaluate alignment of the ankle and foot and make recommendations for an orthotic or refer to an orthotist if deemed appropriate.
Physical therapy at Johns Hopkins All Children’s is provided with one on one care tailored to the active teenager. An emphasis is placed on positive attitude, hard work, along with engaging activities for teen athletes. ACH Sports Rehab helps get athletes back in the game!
How can I prevent PFPS?
Patellofemoral dysfunction can be prevented with:
- Strong and balanced leg muscles that promote proper alignment and biomechanics
- Strong core muscles that allow proper leg alignment
- Proper running and jumping techniques
- Wearing proper orthotics or support if appropriate