Patellofemoral pain syndrome, otherwise known as PFPS, patellofemoral syndrome or anterior knee pain is:
Pain at the knee without signs of any knee joint damage.
Anatomy of the knee
The knee connects the thigh bone (femur) to the shin bones (tibia and fibula). The kneecap bone (patella) articulates with the femur, thus the term “patellofemoral”.
The incidence rates of patellofemoral pain syndrome among athletes are greater than 25% (1), and women are more likely to experience this than males.
Rehab to be able to squat again
I have been experiencing pain in my knee, specifically behind my knee cap region (retro-patellar) as a result of a motor vehicle accident in May 2015. There was no direct hit to my knee, but rather my leg was ‘jammed’ into my hip as a result of the collision, causing a rotation of my hip. I’ve been managing this knee and lower back pain with chiropractic.
Over this process, I have noted prolonged sitting and repetitive weight-bearing lower limb activates aggravates my patellofemoral joint pain, such as lunges and squats.
The LONGEST relationship I’ve had is 10 YEARS and counting! And it is with my beloved exercise called Mr. Squats!
Initially, I had to stay away from squats and performed rehabilitation on my back strength. The back and knee pain should not deter you from exercising at all. It is imperative to get back onto the horse and patiently build your strength back. Stabilising your hips is fundamental to reducing knee and lower back discomfort.
The cause of patellofemoral joint pain is multifactorial
Several factors may include structural or muscular weakness at the knee, feet, or hip joints. Researchers have hypothesied that muscular weakness at the hip may have cause patellofemoral pain (2, 3). A study published in the Journal of Orthopaedic & Sports Physical Therapy documented weakness of hip musculature in asymptomatic knee pain population and reported that:
“The results indicate that young women with patellofemoral pain are more likely to demonstrate weakness in hip abduction as well as external rotation than age-matched women who are not symptomatic.” (4)
Hip and knee assessment will go a long way
If you are experiencing knee pain with exercise, get your hips and knees assessed for injury prevention prior to the training with an exercise physiologist, physiotherapist or a chiropractor.
Try to build your back and hip extensor strength first before you start running, jumping, squatting, climbing stairs, etc. Here is a great “Pseudo-Squat Workout” that will prepare and pre-strengthen your hips and subsequently protect your knees and back for when you actually squat, start running, climb a mountain or simply exercise without knee pain.
Prehabilitation for back and knee dysfunction
You don’t have to have knee or back pain to do this workout. You don’t have to wait till you get injured. Identifying and correcting musculoskeletal imbalances will keep you injury free and will also allow optimal performance! Try out the top 4 rehabilitation and prehabilitation exercises for patellofemoral pain.
1. Arroll B, Ellis-Pegler E, Edwards A, Sutcliffe G. (1997). Patellofemoral pain syndrome. A critical review of the clinical trials on nonoperative therapy. Am J Sports Med,25:207-212.
2. Fulkerson JP. (2002). Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med,30:447-456.
3. Hewett TE, Stroupe AL, Nance TA, Noyes FR. (1996). Plyometric training in female athletes. Decreased impact forces and increased hamstring torques. Am J Sports Med, 24:765-773.
4. Ireland, M. L., Willson, J. D., Ballantyne, B. T., & Davis, I. M. (2003). Hip strength in females with and without patellofemoral pain. Journal of orthopaedic & sports physical therapy, 33(11), 671-676.