Patellofemoral Syndrome

Q-angle (Quadriceps angle)

Patellofemoral Pain Syndrome

Anterior knee pain - What's Going on?

Patellofemoral syndrome (PFS) is the most common affliction encountered in the field of orthopedics. Commonly effecting women, between the ages 12-18 and 24-32, accounts for the most office visits for complaints of anterior knee pain.  PFS can also effect men, but because of anatomical differences between men and women, the later often encounter more problems.  This is because of the "Q-angle" which is a measurable angle for the hip down to the knee, is difference between the sexes.  This angle changes the angle at the knee, and alters the pull of the quadriceps muscle.  The pull on the knee cap or patella is now slightly lateral.  This can cause some compression under the lateral edge of the patella resulting in pain, increased wear, patellar instability and early arthritis.

Symptoms include anterior knee pain, pain in the front or side of the knee cap or patella.  Pain is usually worse going up or down stairs, kneeling or squatting, getting up from a chair, getting out of the car, and commonly hurts if the knee is bent for extended periods at a desk or riding in the car.

The primary treatment is multifactorial.  The old adage "RICE" is definitely part of the regimen.  Rest, ice, compression, and elevation is the treatment for the pain and inflammation.  Avoid aggrivating activities which can be running, but commonly include stairmaster, squats, lunges, and knee extension machine.  Physical therapy is usually required to increase medial quad strength, and improve the flexibility of the ITB (illiotibial band) and lateral retinaculem.

Lateral Patellar Tracking and
Chondromalacia

Bracing and kenesiotaping can be helpful adjuncts to therapy but doesn't address the underlying issue.

Massage therapy can be very helpful to stretch and release the lateral retinaculem and ITB to help improve patellar alignment and tracking. Massage can also help increase blood flow and decrease pain.

Getting the correct treatment is very important to proper recovery and return to activity.  Chronic problems may have a deeper structural cause.  This needs to be evaluated by an orthopedist with a radiograph or x-ray.  If the knee cap is coming out of place or popping in and out, this may need further treatment is physical therapy, massage, and bracing do not help.