Patellofemoral syndrome occurs when the patella and femur rub against one another due to an underlying dysfunction of the muscles that control the leg. Many patients will arrive at the clinic with knee pain under the kneecap, behind the knee, or on the inside joint line of their knee. One of the most common indicators of this condition is a sharp increase in pain during ascending or descending stairs and hills and is common in runners.

Most of the patients that come to the clinic will have had x-rays taken, and are often told that they have cartilage damage. This can be scary news, but not to fear: cartilage damage does not cause pain. There are no blood vessels or nerves in cartilage. Your knee pain is actually due to inflammation of the soft tissue that surrounds the knee, such as tendons, ligaments, and bursae.

That irritation is caused by an imbalance of the muscles surrounding the knee and, to many patients’ surprise, this problem typically originates in the lack of control of their hips and core.

Muscle control of the knee begins at the hips. The anterior muscles (quadriceps) cross over the knee joint via one major tendon that happens to have the patella sitting right in the middle of it. The IT band pulls from the outside, and the adductors pull from the inside. If one of the muscles on the front of the knee is pulling with more force than the others, then the patella could become off track, and given enough time, will begin to rub against the femur. If the muscles on the inside or outside are pulling too hard the tibia can be a little off… Here comes your knee pain!

Physical therapy for knee injuries is handled with in three steps:

  1. Rest, ice, compression, elevation (R.I.C.E)
  2. Manual therapy
  3. Correct the imbalance using specific exercises

The first is to help reduce the inflammation, swelling, and pain. This is typically homework for my patients. The second involves the hands-on stuff. Your therapist may perform soft tissue massage to help the inflammation leave the area and move your bones around to help with joint health. — joints have no blood flow, so the only way to get nutrients to them is to move them. They may also perform trigger point, stretching, foam rolling, dry needling, and other neuromuscular techniques to get the overactive muscles to do less of the work, allowing the critical third step to be effective: correcting the imbalance through specific exercises.

By using these three elements together, patients get the pain relief they want, but more importantly, they actually fix the underlying issue and have a significantly decreased chance of returning symptoms. Yes, physical therapy takes time. It is not a “one and done” approach like pills and a brace, but correcting the problem fully is the best way to avoid that knee replacement down the road.

If you are experiencing knee pain, or seeking therapy for a knee injury, contact one of our Foothills Sports Medicine Physical Therapy offices and a licensed physical therapist can start treating the underlying problem.