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	+ LSSC Home + RehabWorks Home + Rehabilitation Protocols + Instructional Videos + Microbreaks - Sportsmedicine Articles + Ultra-Stretch Program + Anatomy 101 + Back at Work + Pamphlets Online Forms: + Education Outreach Request + Doctor Referral Form + Appointment Scheduling + Initial Paperwork + Patient Survey		Patellofemoral Tracking Many times people, especially women, will experience knee pain in the front of their knee. It is unknown to them what caused the pain and tends to worsen with exercise or prolonged sitting. This pain can usually be contributed to a condition where the patella (kneecap) is not moving correctly in the groove made by the articulation of the femur (thighbone) and tibia (shinbone) known as Patellofemoral Syndrome (PFS). The condition is most commonly seen in runners and athletes but can strike any person at any age. However, PFS is a condition that with a little guidance from a licensed professional can be fixed. What Are Some Common Causes of PFS? It is a common misconception that the patella only tracks up and down, however, it actually moves to the outside and inside as well. There are many muscles that attach and pull on the patella to create the proper movement when the knee is bent and then straightened out again. It is important to remember that causes of PFS are usually multifactorial. Below are some common causes of PFS. Muscle Imbalance- The most typical cause of PFS is and imbalance between the muscles that articulate with the patella. The quadriceps muscles, the iliotibial band (IT Band), the patellar tendon and the adductor muscles all play a role in the movement and alignment of the patella. When one of the muscles or set of muscles (usually the IT band or the quadriceps muscles) is tight the patella is pulled one way and causes discomfort. This can also be caused if one of the muscles is weak and overpowered by another muscle. Bone Alignment- The Q-angle is the relationship between the alignments of the hip and the knee. In other words, do you have wide hips or narrow hips? If there is a wide angle then the muscles on the outside of the thigh have to pull more causing a greater pull on the patella where the muscle attaches. It is imperative that the outside muscles stay stretched for wide hips. Flat Feet and High Arches- A walking mechanism is so important to the alignment the lower body. A person that has flat feet or high arches tend to walk differently then those that do not. Flat feet cause the entire leg to rotate to the inside creating a knock-kneed phenomenon. This upsets the tracking of the patella and pain occurs in the knee. High arches cause just the opposite and create and a bow-legged phenomenon. Again this upsets tracking of the patella. Overuse- Many times doing an excessive movement can cause PFS. Activities such as running long distances or climbing stairs can exacerbate the pain. However, overuse PFS pain may not just be caused when doing exercise. After symptoms have developed, prolonged sitting may be bothersome, for example, after watching a movie (Movie Goers Sign) or sitting at dinner. What Are Some Common Signs and Symptoms of PFS? The most noticeable sign of PFS is general pain in and around the patella. It feels that it is located inside of the knee and cannot be touched or pinpointed. The pain tends to worsen after activities that include bending the knee such as squatting exercises and climbing stairs. Other signs of PFS are: Crunching or cracking sound that is created when the knee is bent. The cracking sound is the sound of the patella sliding back into the patellofemoral groove Sitting for long periods is uncomfortable without straightening the knee to make it crack. The knee swells and becomes tight. What Are Some Common Treatments of PFS? The best way to treat PFS is to see a local health care professional who can guide treatment and physical therapy to ensure that the muscles regain strength and flexibility to help the patella track correctly. It is important to remember, however, that physical therapy takes time and results should not be expected overnight. If this is not an option, or it will take time before you are able to be scheduled, there are other measures that be taken to relieve the pain. Rest- Although complete ceasing of activity is not advised; it is important that activity is reduced and modified. Activities should be non-impact such as the elliptical runner or stairmaster. Another way to exercise is swimming laps in a pool. If Movie Goers Sign is present, this may be relieved by straightening the knee or periodic walking. Ice and Anti-Inflammatory Drugs- Most people do not like to ice because of the sensations felt during the treatment, however, it is the best way to alleviate PFS pain. The treatment needs to be done for twenty minutes every few hours or after activity. Crushed ice, or frozen gel packs. Before activity or if there is not time to ice during the day, anti-inflammatory drugs such as Ibuprofen or Naproxen are good to take. The disadvantages to drugs are potential side effects to the liver and other organs. Contact your doctor if you have been taking anti-inflammatory drugs for an extended period of time. Footwear and Arch Supports- Mechanics of walking can be changed by shoes. If the shoes are old or do not fit correctly walking mechanics are changed to overcome the differences. This change causes the patella to track differently and is the reason for pain. For active runners, it is advised that shoes are changed every three hundred to five hundred miles. Another way to help shoes fit correctly, especially for those with high arches or flat feet, is the use of arch supports. Orthotics can help correct walking mechanics and help PFS. Over the counter arch supports are inexpensive, but it is important to be sure you have the correct type of orthotic. Consult a reputable footwear store for advice on fitting shoes. Surgery- Surgery is not always required, but if symptoms are not subsiding with conservative treatment, it may be necessary. There are a couple of procedures that are considered. A lateral release is the most common. The lateral retinaculum is cut to reduce the lateral pull. Another procedure is to shave the patella to reduce the amount of contact between the bones to lessen the pain. Both are done on an outpatient basis. Can I Use a Brace to Reduce My Symptoms? Braces are a good device to use while exercising. They were designed to minimize the effects of lateral subluxations, dislocations, and decrease improper tracking. However, many times they are relied on to much. It is important to remember that they do not fix the underlying biomechanical problem so they must be used in conjunction with rehabilitation. There are many types of braces to choose from. There a few guidelines to remember when choosing which one is best: They are typically a neoprene sleeve which has the following components: one or more removable straps, a patellar opening, a buttress (felt, gel or inflatable air pocket). They should be snug around the thigh and calf to reduce movement during activity, but it should not restrict knee range of motion. Below is a table of common braces, supplier and approximate cost. Brace Name Manufacturer Cost Bledsoe Sport Max Bledsoe Brace Systems $55 Body Flex Gel Buttress Ortho-Care $34 Lateral J Buttress Support Smith & Nephew $29 McDavid Deluxe Knee Support McDavid Guard, Inc $26 Palumbo Patella Tracker Palumbo Orthopaedic $39 Where Can I Find More Information On PFS? Lateral Release Knee Guru - Proximal Realignment Procedures Wheeless Online General Information Your Orthopaedic Connection Steadman-Hawkins Clinic Rehabiliation Physical Therapy Corner: Patellofemoral Pain Syndrome Other Related Chondromalacia About.com / Orthopedics Patellar Instability World Ortho - Electronic Textbook Arthritis of the Knee Your Orthopaedic Connection The Physician and Sports Medicine Resources DynoMed.com - Patellofemoral Pain The Physician and Sports Medicine - Using Patellofemoral Braces for Anterior Knee Pain Rachel Hildebrand RehabWorks Summer 2005 Intern University of Tulsa
	+ Freedom of Information Act + NASA Privacy Statement, Disclaimer, and Accessibility Certification Editor: Erik Nason NASA Official: David A. Tipton Last Updated: July 15, 2005