Treatment Tips by Tomas Ryan
Ph. Th., BSC., M.I.A.P.T. Physical Therapist

Achy Pain at the front of the knee that is aggravated by running, moving from a seated to standing position, going up and down stairs, seating for prolonged durations, is commonly known as Patellofemoral Pain Syndrome.

Achy Pain at the front of the knee that is aggravated by running, moving from a seated to standing position, going up and down stairs, seating for prolonged durations, is commonly known as Patellofemoral Pain Syndrome.

It is a chronic condition that can be very frustrating for the patient to overcome. To successfully treat such an injury, we must firstly identify the underlying factors that contribute to patellofemoral Pain syndrome. Each of these factors identified below must be addressed when treating this chronic knee pain.

Muscle Weakness

The Vastus medial knee muscle on the inside of the knee joint becomes tired and struggles to function as strong stabiliser of the knee during movement. This fails to counteract the outside pull of outer thigh muscle, Vastus Lateralis which will be overly tight and more active leading to dysfunctional tracking of patella in its underlying groove.

Abnormal Biomechanics

Excessive falling inwards of the foot (Pronation) due to flat feet can cause excessive turning inwards of the lower leg (tibia). This creates pressure on the outside area of the knee during movement followed by abnormal outward movement of the knee cap (patella).

SoftTissue Tightness

• Illiotibial band which lies on the outside of the knee joint is partially attached to the fibers of the lateral retinaculum tendon of outside area of the patella (knee Cap). If the Illiotibial band is too tight then the patella (knee cap) will be pulled abnormally to the outside of the knee during knee bending movement

• Tight hamstring muscles can cause excessive rolling inward movement of the foot (pronation) leading to knee dysfunctional movement. This is because tight hamstrings cause increased knee bending movement which then caused increased ankle bending movement. This leads to excessive falling inwards of the foot (pronation) and hence knee cap (patella) dysfunction & pain.

• Tight Calf muscle reduces the natural ability of the foot to bend towards the shin bone by less than 10 degrees. This restriction forces the subtalar joint of foot to compensate by producing too much movement and hence causing the domino effect of excessive foot rolling inwards followed by knee cap (patella) maltracking.

Finally, a backward tilt of one side of the pelvis can cause a leg length discrepancy and unequal weight bearing distribution on both legs. In addition, the gluteus medius muscle of the hip joint may be weak also causing a trandelenburg gait or swaying gait during movement thus leading to knee pain.

Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles. Contact: 0504 26672. Email your queries to: info@tipp-phyiscaltherapy.ie