Patellofemoral Pain Syndrome (PFPS)
Patellofemoral pain syndrome (PFPS) is a broad term used to describe pain in front of the knee and around the patella, or kneecap. It is sometimes called “runner’s knee” because it is common in people who participate in sports, particularly females and young adults; but patellofemoral pain syndrome can occur in non-runners as well. PFPS may be caused by overuse, injury, excess weight, a kneecap that is not properly aligned (patellar tracking disorder), or changes under the kneecap.
Patellofemoral pain syndrome occurs when nerves sense pain in the soft tissues and bone around the kneecap. These soft tissues include the tendons, the fat pad beneath the patella, and the synovial tissue that lines the knee joint.
In some cases of patellofemoral pain, a condition called chondromalacia patella is present. Chondromalacia patella is the softening and breakdown of the articular cartilage on the underside of the kneecap. There are no nerves in articular cartilage, so damage to the cartilage itself cannot directly cause pain. It can, however, lead to inflammation of the synovium and pain in the underlying bone.
When do we consider overusing our joint?
Repetitive sports can cause overuse injuries. Injuries can be divided into 2 categories, firstly, Macrotrauma which commonly happens in a single traumatic event, e.g, ankle sprain, joint dislocation, or tendon rupture. Secondly, Microtrauma are overuse injuries resulted from frequent use of the joints, fibres and connective tissue of the muscles involving small tears. Overuse injuries rarely show noticeable swelling or bruises, but they can cause tightness, discomfort, tenderness and aches.
The stress-frequency relationship explains how rapid changes in distance and intensity increases the risk of injury. When your muscles and joints are subjected to a stress-frequency combination that is close to high stress but maintained at a low to moderate frequency or low stress with just moderate to high frequency, you are at a safe zone!
In the safe zone, there are positive structure of remodelling and repairing. However, a rapid increase in running distance or intensity may cause the structure to cross the curve, entering the injury region, where breaking down of structure overpowers repairing state, and that is how you get yourself injured.
Patellofemoral pain syndrome is distinguished from chondromalacia. The knee is constructed to take the impact of the body’s weight, bending, and moving. Below the kneecap is a layer of cartilage which acts as a natural shock absorber. Injury, overuse, aging, or other conditions can cause damages to that cartilage. Chondromalacia is a surgical finding, which is a term that describes softening or fibrillation of the cartilage behind the kneecap.
Even though the presentation is similar, it’s often misunderstood. One may have anterior knee pain but not chondromalacia patella, and otherwise. The most ideal diagnosis tool will be X-ray or MRI for this condition. Physicians commonly recommend RICE (Rest, Ice, Compress, Elevate) or anti-inflammatory medications to heal the inflammation at the knee cap. However, biomechanically, a chiropractor will perform adjustments at the pelvic joints to correct leg length discrepancy or compensation from the avoidance of pain.
Some chiropractors will also tailor a strengthening exercise program, targeting especially the inner portion of your thigh muscles (vastus medicalise), with the avoidance of repeating the painful cycle or exercises which require full squat/bended knees with load. Surgical intervention will be introduced when conservative management fails. Chondromalacia patella is not felt to be a precursor to osteoarthritis of the knee. However, if the condition turns chronic and is left untreated; the soft tissues and internal cartilage fails and breaks down, predisposition to osteoarthritis of the knee is required.
Furthermore, strong and supple knee joints are the key to excel in running. A subtle of pain is a notification to ourselves that something requires our attention. Here are some signs to let you know whether or not you need a professional consultation for painful knees.
- Sign #1: You have difficulty walking.
- Sign #2: Sudden onset of other symptoms. (e.g.: Red, Swelling, Bruises, and Heat)
- Sign #3: The pain lasts for weeks! (Even after conservative management such as NSAIDS or Icing)
