Patella - Femoral Pain Syndrome

The patella (knee cap) is essentially a floating bone. It transfers the force of the largest and strongest muscle grouping, the quadriceps (front of thigh), into the lower leg. The quadriceps muscles are utilised in movements involving straightening the leg such as getting out of a chair and going upstairs. They also play a vital role in controlling the rate at which the knee is bent this allows us to perform smooth and controlled movements such as sitting down with out collapsing and going down stairs,

The patella has the thickest cartilage in the body underneath this allows it to glide with less friction. This is very important as it not only moves up and down but is compressed in a groove called the trochlear notch between the femoral condlyes (bony enlargements on the end of the thigh bone) This groove helps prevent the patella slipping sideways and dislocating when performing twist and turns with the knee bent and helps improve the angle of pull of the quadriceps muscles

The patella also relies on the muscles tendons and ligaments that attached to guide through the optimum position in the groove. If it drifts out of position. The high forces it has to deal with are not transmitted evenly and the cartilage tends to wear thin where the compression and friction is greatest.

The cartilage itself is not pain sensitive but the underlying bone is and it’s this which is believed to produce a general discomfort.

It’s unsurprising that this is felt most when the knee is bent as the patella is pulled tighter into the grove. Patients will often feel the urge to straighten the knee when sitting for prolonged periods such as in cinema. Hence this complaint is also referred to as ‘movie-goers knee’. Repetitive loading of a bent knee can exacerbate this further such as going up and down stairs. Patients are not always aware of immediate discomfort it can be after the activity or even the following day.

Our EC2 chiropractors tend to see this type of injury when a marathon runner is stepping up their mileage from 12-15 miles mark. The patella alignment may have been an issue for years but the repetition of running can bring on patients symptoms which makes them aware of it.

The most common causes for this include:

• Localised muscle weakness often medial muscles e.g vastus medialis obliqus (VMO).
• Tight lateral joint structures e.g iliotibial band (ITB).
• Aberrant foot mechanics such as hyper-pronation (flat feet)
• Poor footwear e.g poor arch support/heel cup.
• Poor hip and pelvic stability e.g gluteus medius weakness.
• Physical anomaly such a hip retroversion and increased q-angle
• Over training

treatment

The primary treatment is to reduce inflammation which involves basic RICE (rest, ice, compression, elevation). Our London Chiropractors are trained and experienced in taking a thorough history and assessing lower limb mechanics. This is essential so that the underlying causes are addressed and recurrence rates may be reduced.

Treatment can involve a combination of soft tissue technique, joint manipulations and mobilisations, education, strengthening, stretching, strapping may also be applied to provide relief and improve biomechanics.

In severe cases where the patient is not responding to treatment a surgical opinion may be sort and this often involves performing a lateral release. This is involves cutting through some of the tight structures attached to the out side of the patella to encourage it to sit more centrally in the trochlear groove.  

if you have any questions regarding this injury, please do not hesitate to contact us at enquiries@body-motion.co.uk