Are You Blaming the Train When the Tracks are the Problem?

Written by Penny Goldberg, Owner of Request Physical Therapy


Patellofemoral Pain Syndrome (PFPS) is a common catch-all diagnosis in outpatient physical therapy.  Though this diagnosis is seen most often in adolescent females, it doesn’t discriminate.  Patellofemoral Pain Syndrome symptoms can strike patients of all ages, genders, and activity levels. Knowing more about Patellofemoral Pain Syndrome causes and symptoms can help you identify if you or a loved one suffer from this affliction, and seek out the proper course of treatment if so.

What is Patellofemoral Pain Syndrome?

The patellofemoral joint refers grossly to the anterior aspect of the knee where the patella (knee cap) meets the femur (thigh bone).  The patella is encompassed entirely by the patellar ligament/tendon and functions to increase the lever arm of the quadriceps muscle group.  The femur is designed to house the patella in the patellar groove. When everything is working correctly, the patellar groove and the underside of the patella line up similarly to a train gliding smoothly along its track.  When things aren’t working correctly, patellofemoral joint pain may occur and PFPS may develop.


How to Avoid Patellofemoral Knee Pain

The most critical component to reducing the likelihood of developing patellofemoral pain is hip strength.  This may seem counterintuitive, but it’s true!  Our hips are robust mechanical structures with substantial soft tissue support- the most important of which are the glutes (at least when it comes to PFPS).   

When most people think of their glutes, it’s the bigger, stronger gluteus maximus- the one in the back- that comes to mind.  When we are looking at knee function and what can be the cause of Patellofemoral Pain Syndrome, we can’t completely forget about gluteus maximus, but we need to focus on Gluteus Medius instead.  

Gluteus medius is located on the lateral aspect of the hip and is an abductor and controller of rotation.  When gluteus medius isn’t working well, the femur is allowed to internally rotate which changes the relationship between the patella and the patellar groove. Essentially, the track is no longer smooth under the train.

This dysfunctional relationship is most problematic when the knee is bent leading to symptoms such as: pain with stair climbing, rising from sitting to standing, or prolonged sitting. You may notice patellofemoral joint pain after starting a new exercise program, changing frequency, duration, or intensity of an existing exercise program.  New shoes or changes in playing surfaces may also contribute to Patellofemoral Pain Syndrome symptoms.

Exercises to Reduce Patellofemoral Pain Syndrome Recovery Time

If you’re having Patellofemoral Pain Syndrome symptoms, your physical therapist is a great place to start.  After a thorough examination of your hip and knee biomechanics and functional movement analysis, they will determine where your specific strength deficits lie in order to craft a specialized Patellofemoral Pain Syndrome treatment program for you.  In the meantime, check out some of our favorite exercises to target glute strength deficits and decrease unwanted stress through the knees in patients with occasional or chronic Patellofemoral Pain Syndrome.

  1.     Side Plank Clam Shell


Start out lying on one side with your knees bent to about 90 degrees; your shoulder and hip should be in a straight line. Push yourself up into the side plank position so that your body weight is supported by your elbow and knee. Once you get to the top position, lift and lower your top leg like a clam shell opening and closing. Use your abdominal muscles to hold your trunk still as your leg moves.  If your trunk starts to roll back at the top of your leg raise, you’ve gone too far. For an added challenge to this Patellofemoral Pain Syndrome exercise, add a resistance band just above your knees and feel the burn!

  1.     Posterior Lateral Tap  


This exercise targets patellofemoral knee pain with a simple strength maneuver. Start out standing on your involved side with your knee slightly bent. Using your other leg, reach behind your stance leg in a diagonal direction.  If you were standing in the center of a clock, this would be the 5 o’clock position if you are standing on your left leg and the 7 o’clock position if you are standing on your right leg.  For an added challenge, hold a weight in the arm opposite to your stance leg or try this exercise on a foam pad!

  1.     Standing Fire Hydrant  


Start with your involved side planted with knee slightly bent.  Hinge forward at your hips about 45 degrees and engage your abdominals.  Lift your opposite leg in a diagonal direction while making sure to keep the rest of your body completely still.  For an added challenge, add a resistance band around your knees- for even more, add one at your ankles too! As you build up strength with this exercise, it can be an effective way to reduce your pain and lessen Patellofemoral Syndrome recovery time.

You don’t have to live with the pain if you’ve been diagnosed with Patellofemoral Pain Syndrome. Recognize the symptoms and get the treatment you need by finding a physical therapist near you. You can request an appointment at quality clinics like Request Physical Therapy through the BetterPT website and mobile app. You can start physical therapy for your Patellofemoral Pain Syndrome treatment today without requiring a doctor’s prescription via direct access. Don’t wait to feel better, book an appointment and start recovering today!

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