What is Patella-femoral Pain?  

                            The Basics

First- the patella is a fancy medical word for knee cap... and femur is a fancy medical word for the
large bone starting at your hip and ending at your knee.
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Knee pain can occur for many reasons. If you have knee pain, you should always check with your
doctor before labeling your knee pain with a specific diagnosis. If your doctor has diagnosed you with
patella-femoral knee pain- here is some information for you. By the way, it is the most common
reason for knee pain in young people- both athletes and non-athletes.








Signs and Symptoms:

PFS is pain around the knee cap with one or more of the following symptoms:
  • Pain walking up and down stairs (stair climbing sign)
  • Pain and stiffness after sitting for a period of time that gets better after walking (movie
    theatre sign)
  • Pain after long periods of activity requiring bending at the knees

The athlete typically "sweeps" their hand around the knee cap to explain where their pain is.
("Goldstein sweep sign")

Other injuries and diagnosis typically are described by the athlete to be in one spot- the athlete will
point to one area rather than around the whole knee cap.

If you have knee pain, talk to your doctor about a safe, fast treatment back to sport!

Treatment involves physical therapy including half lunge drills, continuation of sport (in most
cases), and education/reassurance.
Normal patella
Patella-femoral
syndrome Notice the
lower patella "tilted" to the
right
    Xrays can be helpful (Sunrise view) in showing a "tilting patella"- but they are not
    absolutely necessary to make the diagnosis.
    The Science if you are Interested:

    The Patella should fit in the groove of the femur- even during flexion and extension of the leg.
    Sometimes people will have a mis-alignment of their patella causing knee pain NOT involving
    the ligaments such as the ACL, or the cartilage such as the medial or lateral meniscus.

    Pain is caused because of the stretching of the connective tissue holding the patella as well as
    the contact of the underside of the patella rubbing on the femur... thus patella- femoral pain.

    Years and years of uncorrected patella-femoral pain may result in chondromalacia- a condition
    that is often treated with arthroscopic "cleaning" of the underside of the patella. This used to be
    done routinely- even to young adults- now it is usually reserved for older adults- and almost
    never done to adolescents.

    Patella-femoral pain may be caused for several reasons, here are a
    few:



























    If you have knee pain, talk to your doctor about a safe, fast treatment back to sport!

wellbody
Focused on the healthcare of athletes
  • Q angle syndrome:- an angle created by one line drawn vertically through the
    center of the patella and a second line drawn from the outside of the hip to the center of the
    patella. The normal angle for men is 10-18 degrees and for women 15-22 degrees. This
    player has a normal Q angle.
        You might imagine a person with "wide hips" or a larger frame would have a
        larger Q angle and thus a patella that "tilts to the outside"
MVO Dysfunction: The imbalance of hamstrings and the vastus lateralis (the
large quad muscle).  While the patient has relatively strong hamstrings and vastus lateralis
(the large quad muscle) they have relatively weaker MVO (medial vastus obliques).  In the
normal patient the MVO is about 1/5 as strong as the larger vastus lateralis.  In
patella-femoral syndrome the MVO is not even 1/5 as strong. This may cause the patella to  
"tilt to the outside". Physical therapy is helpful. This athlete has a normal ratio of vastus
lateralis to MVO strength.
MVO
Vastus Lateralis


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Flat feet and overpronation: will cause patella-femoral syndrome with the
patella "tilting to the inside". Foot inserts may be helpful in this situation.


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