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Patella Femoral Syndrome & Patella Tendinopathy

Patella Femoral Syndrome (PFP) is a pain that originates around the patella generally deep or at the apex. It is a chronic condition that can also be associated with patella tendinopathy. The current research for the cause and pain of PFP is thought to be a multi factorial condition with both local and distal musculature factors playing a part, all of which causes mis-tracking of the patella when going through knee flexion. Where PFP and patella tendinopathy are different is that it’s the actual tendon disruption that causes the pain and not the tracking where as PFP may tend to have both.


What causes Patella Femoral Syndrome?
The causal factors for PFP can be from an imbalance of muscles and are normally from constant lifestyle movements of sitting or standing in the wrong position for prolonged amounts of time to sporting athletes that are dominantly going through one movement rather than a range of movements through the hips and legs. PFP is when one muscle becomes stronger or tighter than the other, normally the Vastas lateralis over the Vastas medialis oblique. This causes the patella to be pulled towards one side of the patella groove causing the pain.

Patella tendinopathy is when there is normally an overload of the patella tendon causing the disruption of the tendon fibres. This is normally from a sport with a big use of the knee extensors such as sports that repetitively jump or kick. This includes; AFL, soccer, basketball, running, weightlifting and even dancing. These types of sports that cause irritation under the kneecap end up causing PFP and the patella tendinopathy due to the constant stress being placed around the knee. With this in mind it can also be caused by trauma to the kneecap, such as dislocations or fractures and have been linked with PFP. Anything from sports to injury or surgery can causes PFP as it all depends on the patella tracking well through the patella groove.

What are the stages of tendinopathy?  
There are 4 stages for patella tendinopathy, and they are all based around activity. Stage 1 is pain after activity. Stage 2 is pain at the beginning and end of activity. Stage 3 is pain at the beginning,end and during activity but performance is not affected and stage 4 is all of the above but with performance being affected. PFP stages run along the same outline of the stages, but may differ inthe type of activity as it may or may not cause the pain due the orientation of the knee during usethe and the muscles that are most responsible (Rutland, O'Connel, Brismee, Apte, O'Connle, 2010).

How can we help?

Evidence suggests that both open and closed kinetic chain exercises for PFP and patella tendinopathy work best together for short term pain reduction. These can include single leg eccentric squats, VMO leg extensions, clams, side lying hip adductors and decline board squats. Eccentric exercises have also found to show improvement in pain reduction through the knee as itboth strengthens the knee while working on alignment as the patella tracks through the groove giving an insight and an objective measure to the depth and position at which pain may arise (Lack, Barton, Sohan, Crossley & Morrissey, 2015).

If you have knee pain get in contact with us today at Ex Phys Australia either via 1300 869 169 or email us at info@exphysaustralia.com.au

References

Lack S., Barton C., Sohan O., Crossley, K., & Morrissey D., (2015). Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis. British Journal Of SportsMedicine, 49(21), 1365-1376. doi: 10.1136/bjsports-2015-094723

Rutland M., O'Connel D., Brismee J., Apte G., O'Connle J. (2010). Evidence-Supported Rehabilitation Of Patellar Tendinopathy. North American Journal Of Sports Physical Therapy, 5(3),166 - 178.

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