Questions and Answers about treatment for Patellofemoral Pain Syndrome
Who is affected by patellofemoral pain?
Often athletes experience it, particularly in sports where jumping/squatting is prevalent (such as in basketball and volleyball). However, a good portion of the general population experiences this pain, particularly younger and middle-aged women.
What are common symptoms?
Persistent pain in front of or on the inside of the knee is most common. However, pain can also be deep (under) the knee cap. Patients often experience a clicking/popping or gravelly sound in the knee as well. Onset can be sudden, but usually develops and worsens over time with no apparent reason for pain.
Long-terms effects
Serious, long-term problems include degeneration of cartilage in the knee (osteoarthritis). Without cartilage to cushion and lubricate the joints, bone on bone pressure in the knee causes the severe pain, chronic inflammation, popping, and possibly painful spurring.
Old thinking on treatment
Historically, therapy was considered the best option. Traditional therapy has focused on the problem originating from the knee and decreased strength of the inside quadriceps muscle (the VMO). This strength deficiency, it was theorized, caused the kneecap to track or slide outside of its track (where there is plenty of cartilage to provide nutrition, lubrication, and shock absorption). Traditional treatment was then focused on pulling the kneecap back into its track through taping and strengthening of the inside quadriceps muscle. This approach, historically has not been validated in research, and was often ineffective.
New approach to identifying and treating the problem
Within the past 4-5 years, a new school of thought surfaced: rather than look at where the pain and problem are occurring, consider why it’s happening. The problem actually originates in the hip rather than the knee. The reasoning is that the knee only does what the hip and foot allow it to do – much like a door: If a door isn’t closing properly, you can’t just look at the side of the door to fix the problem, but need to look at the hinge itself. The hip is the “hinge” on which the knee operates. The hip is the body’s center of gravity and if the hip rotates forward too much, it forces the femur to the inside, displacing the knee cap to the outside, and causing it to “go out of its regular track.” This is what causes patellofemoral pain.
The new treatment
The new therapy that follows this revolutionary way of looking at the problem is still not widely known and used. The treatment involves use of a portable resistance device (a brace of sorts) that gives resistance to the hamstring muscle (in the back of the upper leg). It activates and retrains the hamstring muscle to pull the hip back, which in turn rotates the knee back out so the patella (kneecap) can properly slide in its designated track.
A therapist trained in this approach to treatment of patellofemoral pain uses four different screening tests to determine if a patient is a good candidate for this treatment.
Once fitted for the device, the patient simply wears it for 1 hour in the morning and 1 hour in the afternoon, and does hamstring curls 3 times a day. Weekly or bi-weekly, the patient’s therapist uses various exercises and tests to adjust the resistance level needed
Expected course of treatment
By the time they get to appropriate therapy, most people have suffered the pain for many years and have tried the whole gamut of treatment options (including traditional physical therapy). But if patients are appropriate candidates, they often experience decrease in pain with activity and functional improvement on the first visit. They can usually find lasting relief in just 6-8 weeks with the new therapy.
Availability of treatment
The therapy is not yet widely used among physical therapy providers in St. Louis because it is a relatively new approach. SSM Rehabilitation Hospital physical therapist Aaron Robinson first learned of the approach in Memphis when it was introduced in 1998. He brought it to SSM Rehabilitation Hospital and trained other therapists. SSM Rehabilitation Hospital is now the most comprehensive provider of the treatment in St. Louis, offering it at many of its 22 outpatient therapy sites.
This treatment can also be helpful in treating some back pain issues, especially if someone suffers back and knee pain. The device adjusts and maintains a person’s pelvic position, relieving pressure on the lower back, sciatic nerve and patella.
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