Knee pain is a common complaint of clients attending physiotherapy. One of the more common conditions is pain around the kneecap termed ‘patellofemoral pain syndrome’ or PFPS.
This condition is more common in young women and is typically worsened with physical activity, walking down stairs or hills, squatting and sitting with the knees bent.
Abnormal tracking of the kneecap creates irritation of the soft tissue around the knee resulting in pain. There are numerous factors that contribute to the abnormal tracking.
These factors can be divided into:
Bony / Structural
- Rotated hip bones
- Increase leg angulation (i.e. wider pelvis)
- Kneecap position
- Excessive probation of the foot (i.e. flattening)
Soft Tissue
- Muscle tightness around the hip and knee
- Muscle weakness, especially of the hip and quadriceps muscle
Training Changes
- Increase in training load or unaccustomed activities
- Change in training surface
- Change in footwear
The patient typically attends physiotherapy complaining of a generalized ache in the knee, sometimes more outside than inside. The pain can be worsened with stairs, squatting, kneeling, and sitting. There also may be complaints of crunching or grinding in the knee, which is termed ‘crepitus’. There may also be complaints of knee swelling or puffiness.
The physiotherapy exam will consist of a thorough history and physical examination to determine the causes of the PFPS and come up with a treatment plan to reduce and eliminate the symptoms.
Typical manual physiotherapy treatment will consist of correcting any lack of mobility in the spine, pelvis, hip, knee and ankle/foot. A common finding is tightness in the soft tissue around the kneecap pulling the kneecap to the outside.
A taping technique called McConnell taping (named after the Australian physiotherapist who discovered the taping) is very useful in realigning the kneecap. This realignment improves the tracking of the kneecap in the groove. With correct taping, symptoms are typically reduced immediately.
While the kneecap is taped and the pain is reduced, a strengthening program can be initiated. The strengthening will focus on the Vastus Medialis Obliqus (VMO) and hip muscles. The VMO is the only quadriceps muscle that helps pull the kneecap to the inside. With re-training, the VMO can resume controlling the kneecap. The hip muscle’s strength is important in controlling and stabilizing the knee.
In summary, manual physiotherapy can effectively reduce PFPS through a combination of manual therapy, taping and exercise.
