Patellar Femoral Syndrome – Fix Your Knee Pain

Do you have knee pain walking down stairs? If so you may be suffering from PFS / Patellar Femoral Syndrome.

During this series 4-part series we will take an in depth look at the 4 most common knee issues and conditions people face. We will examine the causes, guide you through corrective exercises and show you how to implement the necessary exercises to prevent this from occurring. The aim is to get you moving, improve your abilities and celebrate your new movement capabilities.

What is Patellar Femoral Syndrome?

PFS or Patellar Femoral Pain Syndrome is also referred to by some as or Chondromalacia Patellar Syndrome. The Patella is a fancy name for your knee cap. Chondromalacia can only be confirmed if we put a scope behind the kneecap and confirm that the patella is roughened up on the back. But until we do that, we can treat this as a case of PFS.

It is the pain right behind the kneecap (patella). It can be a dull aching pain that is irregular in occurrence, or it can be a constant dull aching pain that slowly build up with time and increases in intensity. The pain behind the knee can be experienced in any activity that places strain on the knee like skiing, running, cycling but most prevalent in climbing stairs but more so coming downstairs. It is found mostly in the adolescent and adult groups and more under females due to the angle of the knee. The knee can also be sensitive in typical resistance training when doing squats and lunges. You may also be experiencing crunching noises that we call crepitus.

How is Patellar Femoral Syndrome caused?

The main reason is that the quad attachments are tremendously strong and apply a lot of pressure on the knee where the quad attaches at the patella. Along with possible tight glute muscles, a weak Vasti medialis oblique (VMO) that is responsible for knee stability, and tight ITB that run on the lateral outside of the hips and thigh can cause the patella to shift slightly towards the outside when the knee is bending during activity and movement. If you squat with knees turning inwards you’ll know what I mean. This sideways movement disrupts the mechanical relationship between the kneecap and the groove that the kneecap normally slides in. Even the smallest shift off this track can cause discomfort in the knee over a period of time.

Do I really have Patellar Femoral Syndrome?

There is only one way to really pinpoint if you have PFS, and we will need some tape for this. I’ve mentioned that the pain is caused if the patella moves sideways to the outside of the leg. If we tape the patella and pull it slightly back inwards to its normal position in the goal to lower the pain. It affirms that there is a good chance that you have PFS. So here is what we’ll do:

Step 1  – walk up and down a few flights of stairs and focus on how much pain or discomfort you are in.

Step 2 – watch this video on how to tape your knee. After the taping is done go to the same flight of stairs and repeat the movement. Notice if you are in less pain. If so, we can confirm that you have a degree of PFS. This is due to the taping slightly changing the mechanical relationship of the knee.

What are the 2 common causes of Patellar Femoral Syndrome?

1. The 1^st typical scenario is when a person enrolls in a new training plan and it’s a matter of too much, too soon. A steady increase in resistance load or volume is always a safe and effective way to increase working capacity and strength and allowing sufficient time to rest between sessions.  As an example – you start jogging after work on a recreational basis. You start off with a 5 km run for a week but increase it to 7km the next week and then to 10 km in week 3. This is a common occurrence for people who enter races or push themselves hard to reach a goal in a short space of time. In this case the person increased their load / volume by 100% in 3 weeks. Where a 5-10% rule per week is ideal to allow the proper conditioning and recovery in a case like this. Too much, too soon.
   
2. The second scenario is common for individuals who are well conditioned and not new to exercise at all.  These active individuals go to the gym or CrossFit box a few times and often enroll in road races, tri Athlons, competitions and adventure races.  After a short layoff of training due to a busy time at work or taking a break on vacation they feel rested and return with a bang. They attempt to lift as heavy as they did or run as far as they did before they went on a break as they feel fresh and are ready to return to action right away. Once again, it is a matter of too much too soon. The ideal way is to increase the volume or load gradually. Here we have a typical scenario of conditioning vs. deconditioning. Once you are well conditioned your body can handle and recover from just about anything that you have been conditioned to. When resting or taking some time off you lose a bit of that conditioning and become slightly deconditioned. You don’t lose all your hard work but just some of it.

Fact is you need to steady start reconditioning to become more conditioned and be less deconditioned so that your muscles and joints are gradually built up and can withstand the forces you apply to it😊

How do we fix Patellar Femoral Syndrome?

We are looking at a possibly 3 factors that play a role here:

1. Tight glute muscles – that need to be corrected by lengthening, stretching and guided to move the correct way when performing knee flexion movements like squats and lunges, running and cycling.

2. VMO – that need to be corrected by strengthening the VMO by isolating the muscle movement and increase its functional working capacity by reintroducing the correct movement pattern with the rest of the knee flexors in the quad and hamstring.  An easy example is to hold a half squat position during a wall sit with your knees slightly wider than your normal squat stance.

3. ITB – that needs to be corrected by lengthening and stretching but also conditioned to recover. This is a very active structure, the ITB is under tension pretty much throughout the whole day while standing, walking and also training. The ITB is a series of connective tissues, so simply foam rolling it isn’t going to dramatically change everything.

Your body is essentially a soft tissue mechanism and can adapt to changes in environment. That means if you consistently apply a method. Regardless if it is the incorrect or correct method your muscles and movements will adapt to your habits. Therefore, we can correct and change your weaknesses in strengths and change tour tight areas into subtle moving strengthen structures. The VMO, tight gluteus and ITB can be corrected so that they function and move the way they were designed.

Here is a very handy routine you can do at home or combine with your regular training:

1. Ball squeeze extensions (inward rotations) x 20 reps x 2 sets as to isolate the VMO.
2. VMO extensions (inward rotations) x 20 reps x 2 sets as to isolate the VMO and knee stabilizer.
3. Towel slides (backwards) x 10 per leg x 2 sets for a closed chain VMO knee stabilizer exercise.
4. Lying leg raises x 20 per position (3 positions) for gluteus Medius strengthening to stabilize the hips.
5. Quad / Rectus Femoris stretch at least 60 seconds (Across) to loosen and lengthen the strong attachment points that place so much pressure on the patellar kneecap attachment. 
6. Side glute raises x 20 per side to strengthen deep inside the glute Medius that’s assist in hip stability and leg lifting / abduction.
7. Glutes stretch at least 60 seconds per stretch to cater for the glute group tightness.
8. ITB rolls x at least 60 seconds for the tightness applying lateral pressure on the patella.

What’s next?

In short your knee alignment issues mainly originate at the hip. This is why we are addressing the muscles in the thigh, knee and hips. Some work will have to be done on your part to strengthen and support these structure. Rest may seem fine temporarily, but in the long run you are going to need to do some work here.

In the next part we will examine the pain on top of your knee cap. Patellar tendonitis / jumpers’ knee is quite common under our active adult population. If you are feeling knee pain on top of the kneecap, then this one is for you. The symptom is on the kneecap, but the issue originates at the hip and lack of strength and adequate rest are main contributors.