Knee cap pain-Patellofemoral Pain syndrome

The Patella, commonly known as the knee cap, is an essential bone in the knee joint that acts as a fulcrum for our quadriceps, (the thigh muscles), to help gain mechanical advantage for extending your lower leg.  The patella is roughly triangular with the apex of the triangle articulating with the femur bone and it is the largest sesmoid bone in the body.  It is equipped with some of the thickest cartilage on this inferior surface.  The knee cap is stabilized within the grove of the two femoral chondyles with the balance of the musculature and ligaments around it.  This is largely made up of the quadriceps muscles. When there is trauma or a muscular imbalance at the patella, pain occurs.

Symptoms of Patellofemoral Pain Syndrome (PFPS)

PFPS can affect everyone with women and young adult athletes being affected the most. The main symptom of patella-femoral syndrome is pain under or around the knee cap but other symptoms include:

-pain going up and down stairs, (usually more descending stairs)
-pain squatting
-pain kneeling 
-swelling around the knee cap
-knee pain when getting up after sitting for a period of time
-grinding or popping when moving the knee
-increases pain with activities that involve jumping or running

Causes of Patellofemoral Pain Syndrome

Trauma can be a cause of PFPS when  a person falls directly onto the knee and drives the knee cap into the joint.  This causes injury to the cartilage under the patella and joint irritation.  Gradual onset of PFPS is the most common presentation.  There is no one common cause of the condition but often an imbalance of knee cap musculature is at the root of the problem. 

Common aggravating factors to this include:

-Over use of the knee joint when the knee musculature isn't capable of handling the stress
- repetitive exercise that causes an imbalance of musculature around the knee. (example: cycling can build up the lateral leg muscles greater than the medial ones)
- weakness in the hip and back muscles causing an imbalance down the mechanical chain
-Increased pain when playing sports on hard surfaces 
-Certain body types with an increased angle at the knee are more prone to PFPS
-Flat feet or other foot conditions
-improper footwear or changing footwear can flare up PFPS

Treatment of Patellar-Femoral Pain Syndrome

Initial Treatment
Inflammation should be initially managed if you have a flare up around the knee cap that involves pain and swelling.  The classic RICE method should be used:
R- Rest. Decrease or eliminate the aggravating activity
I -Ice. Place ice on the knee in intervals of 15 minutes an hour (don't place directly on skin)
C- Compression. Lightly wrap the knee in a compression bandage, leaving a hole for the knee cap.  Ensure that it doesn't cause more pain when wrapped
E- Elevate.  When you are able, elevate your leg when resting throughout the day.

Medications
Initially, the use of anti-inflammatory medication is appropriate for those who can take them.  They should not be used for over 2 weeks without consulting with your doctor. 
 
Therapy
Conservative care is the appropriate treatment as surgery is rarely needed.  A thorough examination of the leg, hip and back musculature is needed to asses if there are any weakness in the biomechanical chain.  Secondly the feet should be checked to see if there is extra force being placed on the knee due to improper foot mechanics.  
Initial therapy may include modalities such as ultrasound, current, TENS, massage and adjustments to the hips and spine.  It will be determined if you have an imbalance in the musculature and an exercise program will be implemented. 
Common exercises for PFPS include:
a) Stretches
-quad stretch (heal to bum)
-calf stretch (foot up the wall or hang heal over a step)
-hamstring stretch ( sitting toe touches with a straight leg)
- IT band and glute stretch ( sitting with knee bent and pull the leg across the body)

b) Exercises
-shallow wall squats
-glute exercises including clam shell, side leg raises and rear leg extensions
- sitting leg raises with no weight
- lay on your back and lift your leg off the floor 8 inches and hold for 20 seconds
- stand on one leg and slightly bend your leg and hold for 10 seconds

These are some common exercises prescribed and may be different depending on the cause of the imbalance.  Always remember to stop if the exercises hurt, warm up before and cool down after exercising.  

Pay attention to knee pain around the knee cap when it starts.  Listen to your body and get an examination to see if you are starting to develop PFPS.  Find the imbalance and correct it and therefor stop  any progression of chronic knee pain. 

Activity fact: long-term studies have found that runners have less incidence of knee osteoarthritis. One study that followed runners and nonrunners for 18 years found that, while 20% of the runners developed arthritis during that time, 32% of the nonrunners did!