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Patellofemoral Pain Syndrome

What is Patellofemoral Pain Syndrome?

Patellofemoral Pain Syndrome - Physiotherapy Treatment TorontoPatellofemoral pain syndrome is a common condition that affects the knee joint and can be related to discomfort in the knee while participating in weight-bearing activities. The cause of the pain is related to abnormal contact between the kneecap and the femur (the thigh bone) due to imbalanced forces from muscles and tissues around the kneecap. Often there is a stronger pull on the outside of the kneecap from structures such as the iliotibial band (ITB) the lateral retinaculum or the vastus lateralis (outer quadriceps muscle) that cause the kneecap to be pulled outwards. Normally, the kneecap sits in particular grooves on the femur and tracks up and down while our knee bends and straightens (similar to a train on train tracks). When an imbalance of muscle and tension exists, the kneecap is shifted off the grooves. When this situation is combined with repetitive motions of the knee such as in running, injury and pain can develop.

How do you know if you have Patellofemoral Pain Syndrome?

Usually individuals with patellofemoral pain syndrome complain of pain during weight bearing activities such as walking or running. The pain is usually localized to an area under the kneecap or around the knee cap. Also, individuals who suffer from patellofemoral syndrome report increased pain when walking down stairs more than walking up stairs. There may have been a specific trauma to the knee but more often this condition develops gradually over time as a result of repetitive activities and muscle imbalances.

Physiotherapy or Chiropractic treatment of Patellofemoral Pain Syndrome?

The most effective, long-term and evidence based treatment for patellofemoral pain syndrome is treatment from a physiotherapist or chiropractor.

A physiotherapist or chiropractor will look at your whole lower extremity to determine where your imbalances stem from. Sometimes weak hip and core muscles can cause this issue. Weak ankles, fallen arches or decreased range of motion in one area of the lower leg can also be the culprit. Either way, the best physiotherapists or chiropractors will determine the root of your patellofemoral pain and will target their treatment accordingly.

Your treatment will consist of a combination of manual “hands on” treatment, specific prescriptive exercises and other modalities such as laser, electrical stimulation or ultrasound depending on how your condition presents. Your physiotherapist or chiropractor will also help you progress so that you know how to gradually return back to your sport or activity. Other treatment strategies include taping, bracing, registered massage therapy, acupuncture, dry needling or Gunn IMS.

How can I Treat Patellofemoral Pain Syndrome at Home?

If you suspect that you have patellofemoral pain you will want to do the following things:

  1. Ice the knees after aggravation
  2. Modify your activity or cross train (to avoid further aggravation)
  3. Release the outer thigh on a foam roller or another myofascial tool
  4. Start a strengthening and stretching program.

Best Exercises to help with Patellofemoral Pain Syndrome?

Glut Medius Strengthening


Perform strengthening exercises 10-15reps 3sets a day.

Stretching IT Band

There are two ways to stretch the IT Band. One way is to use a foam roll or release the side of your thigh. The second way is to stretch it. To stretch, cross the foot of the leg being stretched across your body. Then take your arm on the same side and stretch it overhead and across as well. This will make a large C curve with your body. Keep your pelvis still and level and feel the stretch from your hip towards your knee.
Hold 30 sec repeat 3x twice a day.

Stretch Quadriceps

This muscle group is on the front of the thigh. To stretch in standing grab your ankle behind your body and pull your knee into deep bend. Make sure from the side view your knee is in line or slightly behind your hip in space.
Hold 30sec repeat 3x both sided 2-3xday.

What should be avoided if I have Patellofemoral Pain Syndrome?

It is important that you modify or stop the aggravating activity at the onset of your pain, do not try to push through your activity and deal with it after. Also, if the symptoms are not resolving in a 2-3 week timeline it is best you book an assessment with a professional, be it a physiotherapist, chiropractor or sports medicine doctor.

What should be avoided if I have Patellofemoral Pain Syndrome?

If the root cause of the pain is discovered and addressed you should be back to your activity in about 8 weeks, plus or minus a week or two. If your injury is more severe, becomes re- aggravated frequently or the root cause is harder to find (because there may be multiple factors all interfering with the condition) then recovery may take longer.

Patellofemoral dysfunction that results from gradual build-up means that your habits and poor movement strategies caused this issue. Once healed, you may have to continue with an ongoing maintenance exercise program to prevent these bad habits from re-surfacing. For example, if your activity is running you will want to have a pre-running warm up that includes firing up the glut and hip stabilizers. This should also be complimented with a bi-weekly (or more) strengthening program focused on core, pelvis and hip stability.

Don’t wait too long before you have someone take a look at your knee. Book with one of our experienced physiotherapists or chiropractors today so that you can get back to enjoying your activities and sports sooner and without discomfort!

Alishah Merchant, FCAMPT Physiotherapist

Alishah Merchant is a FCAMPT physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.

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Yonge & AdelaideRebalance Clinic Yonge Adelaide
110 Yonge Street Suite 905
Toronto, ON M5C 1T4
T: (416) 777-9999
E: [email protected]
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155 University Avenue Suite 303
Toronto, ON M5H 3B7
T: (416) 306-1111
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