Patellofemoral Pain
Sometimes called "anterior knee pain" or "runner's knee," patellofemoral (pa-tell-oh-FEE-mor-al) pain syndrome (PFPS) is a condition that causes pain behind or around the kneecap, and it is the most common cause of knee pain. The pain is usually worse when the knee is bent, or while walking downstairs or downhill. A person can suffer from PFPS in just one knee or both knees.
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Diagnosis
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A physician can often diagnose PFPS by examining the patient and discussing his or her symptoms. The doctor may order a test, such as an X-ray or MRI, to eliminate other possible causes of knee pain, or if the patient's pain doesn't improve with treatment.
Treatment
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Doctors recommend reducing activities that place a load on the knees. Athletes whose training causes knee pain can switch to exercises that are easier on their knees, such as swimming or biking, while they are recovering from PFPS. Icing the knee after exercising can provide some relief; using heat for pain relief is not recommended for PFPS.
Medications such as acetaminophen (Tylenol®) or ibuprofen can help with the pain, but there is little scientific evidence that these drugs have any benefit for PFPS other than pain relief. Braces or other supports sometimes help to relieve the discomfort of PFPS, but have not been proven to help in recovery.
Although it may not be obvious, many people with knee pain may benefit from seeing a podiatrist. Problems with the feet or ankles may lead to an abnormal gait, which can contribute to knee pain. If necessary, a podiatrist can make a custom orthotic device to wear inside your shoes, and can also help you choose the proper shoes to wear and teach you exercises to stretch your calves and Achilles tendon. There are also orthotics for sale over the counter that can provide support and cushioning for the foot.
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Physical Therapy
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Physical therapy is the main treatment for PFPS; many studies have shown physical therapy to be very effective. Physical therapy can correct many of the problems that lead to PFPS, such as weakness or tightness of muscles, or tightness of ligaments. Physical therapy exercises usually include stretches for the hamstrings, quadriceps, calves and iliotibial band. Some people use a wedge or half-moon-shaped device to help them stretch their calves. Physical therapy also usually includes strengthening exercises for the quadriceps and special squats designed to strengthen the muscles of the legs without putting too much stress on the knee. (See resources for pictures and descriptions of exercises).
Prevention/Solution
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As with all medical problems, prevention of PFPS is the best option. It is very important to listen to your body during your workouts and the day after. Keeping a journal of your training regimen can help you to identify any exercises that are causing knee pain so you can make the necessary changes to your training. A certified personal trainer can teach you the proper form for exercises.
Runners need to pay particular attention to their knees---PFPS makes up 16 to 25 percent of injuries in runners. Runners should increase their mileage gradually. Runners who do not stretch properly are prone to developing tight muscles in the backs of their legs, so it is essential to stretch regularly and well, particularly the calves and hamstrings. It is also important for runners to wear the correct shoes. The right shoe is one that is made specifically for running and will have good cushioning, as well as any corrections you may need for gait problems such as overpronation, when the feet roll inward.
Considerations
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Since different problems can contribute to PFPS, there is no single therapy that will be perfect for everyone. For people who need physical therapy for PFPS, it is essential to have a good physical therapist who will do a thorough evaluation of the problem. The physical therapist will work with information from your doctor and design a program that is right for you. Since weakness of the quadriceps requires a different program from tight hamstrings, the expertise of a physical therapist is an irreplaceable tool for rehabilitation.
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