By: Brad Homan, D. O.
Pain in the front of the knee is one of the most common knee problems and it is often difficult and frustrating to manage. People of all ages are affected, and it occurs in both athletes and non-athletes. Females seem to experience this condition more often than males. Patella pain may be very sharp or aching. The pain is usually worse with ascending or descending stairs or other physical activity. Often people affected with patellofemoral syndrome feel aching pain in the front of the knee with prolonged sitting and need to straighten the knee for relief. In general, the patellofemoral syndrome occurs from abnormal pressure on the kneecap. Forces nearly seven times body weight act across the patella during routine activities, so even a small amount of abnormal tracking can cause significant discomfort.
So what causes abnormal patella tracking? Unfortunately the answer is not always easy to figure out. Many factors contribute to normal patella motion, including bony anatomy, ligaments and muscle forces. Abnormalities in any of these can lead to anterior knee pain. For example, abnormal foot placement during walking or muscle weakness at the hip or knee can lead to an abnormal pull on the kneecap. Abnormal alignment of the leg bones may also cause patellofemoral pain.
As you can imagine, some causes of abnormal patella motion are not easily corrected. However, most cases of anterior knee pain can be improved or resolved by nonsurgical means. For the most part, abnormal forces will tilt or pull the kneecap to the outside of the leg. Therefore, if one can help tilt or pull the kneecap back to the inside the pain will improve. The good and bad news is that this involves strengthening the quadriceps muscles, most importantly the one on the inside of the knee called the vastus medialis obliquus. Stretching must also be included in the exercise routine. A simple brace and use of anti-inflammatory medication such as ibuprofen may help relieve pain until symptoms resolve. Patience is a must—strengthening the muscles may take months but in general one should notice improvement in about six weeks. Other disorders can cause pain in the front of the knee, so consultation with a health care professional may be beneficial. With patience and diligence one can overcome the patellofemoral syndrome and get back to sport, or back to life!