Patellofemoral syndrome is a common cause of knee pain. It generally presents as anterior knee pain, or pain in the front of the knee. Patellofemoral syndrome is a problem of the tracking of the kneecap within the knee. Essentially, see here’s a knee, this is the patella, the knee cap. And there’s a groove in which the knee cap is supposed to glide as one goes through life bending and flexing and walking and sitting. When the knee cap doesn’t track in that groove properly, you can get some friction, some inflammation on the bottom of the knee cap that can lead to just inflammation, or a little arthritis, a little chondromalacia patella, some irritation of the knee cap, and that can be painful. Typically, it’s going to present as pain, like we said, in the front of the knee.
It’s usually really painful when you go down stairs, that’s often very painful for patients when they have patellofemoral syndrome. When people sit for a long time, they’ll often feel like they have to straighten their knee because the pressure builds, builds, builds, and straightening, the pressure relaxes some. Patellofemoral syndrome is primarily a biomechanical problem, so the way you go about treating it, often, is by addressing the biomechanics. Typically this means stretching the hip flexor, stretching the iliotibial band, which will — which comes down the outside of the leg and attaches down at the bottom of the knee and can pull the knee cap to the side.
Typically when the knee cap is not tracking properly it is tracking laterally, or to the outside of the knee. And then strengthening the quadriceps, ideally strengthening the inside (the VMO, the inside of the quadricpeps) in order to get the kneecap back in alignment. Also looking at the feet is important to make sure that if the person has any flat feet or hyperpronation of the feet, that gets addressed as well so that the mechanics get restored throughout the entire kinetic chain.
While the hallmark of treating patellofemoral syndrome really is addressing the biomechanics, as you’re going through physical therapy, if the pain is getting in the way of somebody getting better with physical therapy, or being able to participate with physical therapy, then there are oral medications that one can take in order to help with the pain and some of the inflammation.
There are topical medications, like topical prescription medications like Voltaren(r) gel, Pennsaid(r), or Flector(r) Patch, that are basically topical diclofenac, or topical non-steroidal anti-inflammatory drugs like Advil(r) or Aleve(r). And it just diffuses right through the skin, and that can be somewhat helpful as well with patellofemoral. It’s not going to fix it, because again, we really need to address the mechanics, in order to really get it better, but it can help along the way.
And in a similar vein, one can do different kinds of injections like hyaluronic acid injections, which is basically putting some joint fluid into the joint in order to help lubricate the joint, which again is not going to fix the biomechanics but can help open up this window of opportunity during which the patient can participate more fully with physical therapy and sort of breakthrough a plateau in order to really make a full recovery.