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Could you be suffering from patellofemoral pain? What Is Patellofemoral Pain? Patellofemoral pain is felt behind and around the kneecap and is due to irritation between the kneecap (patella) and underlying groove of the thighbone (femur), often from overuse of the knee. The patella slides in the groove and is held in place by quadriceps muscles and tendons attached to the inside and outside edges of the patella. The patella functions to increase the force of the quadriceps thigh muscles to straighten the knee. Many factors can cause alignment changes of the patella in relation to the femur and this will affect the smooth gliding of the patella causing irritation and possibly damaging the under surface of the patella if left untreated. When Does the Pain Commonly Occur? Pain is often felt with walking, running, on stairs, squatting and prolonged sitting (movie goers' knee) and can be accompanied by grinding or clicking noises, a sensation of weakness, giving way and swelling. What Factors May Predispose to this Condition? Tight muscles and tendons attached to the outside edge of the patella Weak or inactive muscles attached to the inside edge of the patella Extremes of foot posture i.e. pronation Mal-alignment of the knee joint A patella that sits abnormally high or low Tight calf, hamstrings, quadriceps or hip muscles Poor pelvic stability and knee control What Type of Treatment Is Involved? Activity modification to reduce any irritation to the patella. This may involve avoiding propulsive maneuvers, activities requiring quick change of direction, running or jumping. The application of ice for swelling of the knee and pain control. The application of tape to correct patella alignment and to provide proprioceptive feedback. The application of tape to correct foot and ankle alignment. This may include increased pronation or supination of the mid foot or increased inversion or eversion of the calcaneus. Manual therapy techniques to release and inhibit overactive muscles. These muscles are often the lateral quadriceps, hip flexors (Psoas major), ITB and tensor fascia lata (the muscle belly of the ITB), the hamstrings and calf (gastrocnemius, soleus, peroneal muscles, tibalis anterior and posterior). Stretching to increase flexibility of overactive or tight muscles. Typically Stretches for the hip flexors, quadriceps, hamstring and calves are given. The stretches will often be held for 30-60 seconds and repeated 3-6 times per day. Your physiotherapist may show you self-releasing techniques with a ball or foam roller for the ITB, tensor fascia lata or hip flexors. Your physiotherapist will provide you with a home strengthening program to improve knee and pelvic control. The home exercises will be designed to increase the strength and endurance of the vastus medialis oblique muscle (VMO), which is the medial quadriceps muscle and the most important for knee stability. You may expect to perform exercises to improve the strength and endurance of the gluteal minimus and medius, pelvic floor and abdominal muscles to help stabilize the hip and pelvis. Strengthening exercises for the hamstring and calf muscles or exercises to improve foot and ankle stability may be given if this is a predisposing factor. The following are examples of exercises that may form part of your home exercises program: Squats, wall squats, lunges, calf raises, bridging, abdominal curls, one leg stance practice, one leg squat, squat on wobble board, balance exercises on wobble board and return to sport drills. Remember that physiotherapy management is also dependent on your primary goals. Lively Physiotherapy & Pilates Studio Ground Floor 1394 Pacific Highway Turramurra NSW 2074 (02) 8065 0715 www.livelyphysio.com.au How long can I expect to need treatment? Treatment can last from weeks to months depending on the severity and will involve correcting the predisposing factors. If you would like further information or would like to make a physiotherapy appointment please call Lively on (02) 8065 0715.