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Advanced Information For Health Professionals Regarding:

Knee Pain (Patello-Femoral syndrome)


Definition:

Displacement of the knee cap as it tracks over the femur. This causes inflammation and pain at the underside of the patella.

Symptoms:

The patient complains of a nagging pain beneath or on the sides of the kneecap during activities like walking up-stairs or getting out of the car. In addition, a dull ache may occur after sporting activities or getting out of a chair. Also, the patient experiences a crunching/clicking (crepitus) sensation around the knee cap. Sometimes swelling is present.

Biomechanical etiology:

Excess internal tibial rotation, is directly associated with excessive pronation. Therefore, medial displacement of the patello-femoral path encourages lateral displacement of the patella. The cartilage under the patella will eventually soften, resulting in pain and inflammation under and about the patella, especially with excess loading activities such as running. The cartilage becomes damaged because the patella is not sliding smoothly over the patello-femoral path. Subsequent wasting of the Vastus Medialis Obliquis (VMO) commonly occurs. In addition, the quadriceps, which are important in proper tracking of the knee cap - may be weakened (or fatigued in athletes), thereby displacing the patella further.

Treatment:

Common treatments involve the reduction of pain and balancing of soft tissue structures. However, knee pain commonly associated with excess pronation responds well to foot orthotics. Orthotics effectively replace the natural footprint and provide a stabilising angle for the calcaneus. This calcaneal angle reduces calcaneal eversion associated with excess subtalar joint pronation and limits secondary internal tibial rotation. Pre-molded ORTHAHEEL orthotics or custom VASYLI Moldables (full-length model for athletes).

Additional treatment: Ice therapy (15 min. 3-4 times per day), muscle balancing.

Exercises:

• Strengthening of the quadriceps, especially the VMO
• Stretching of quadriceps and hamstrings