Anterior knee pain, often diagnosed as Patellofemoral Pain Syndrome (PFPS), is a common complaint in the chiropractic office. This complaint is typically from runners and other endurance athletes who are overtraining, but can also be due to increased load on joints and repetitive impact from running or jumping. The pain will be centralized to the front of the knee, feel achy, and get worse when moving up or down stairs. It may also ache while sitting for prolonged periods.
The knee is a hinge join connecting the femur to the tibia, and allowing for flexion and extension. The patella, or knee cap, is a bone that receives the quadriceps tendon and links it across the knee joint to the tibia via the patellar tendon. It also acts to protect the articular surface of the knee. As the knee moves through its range of motion, the patella moves in combination, tracking up and down, tilting and rotating to help facilitate proper body mechanics. Traditionally, anterior knee pain has been attributed to improper tracking of the patella. It is theorized that the muscles acting on the patella are weak or tight, pulling it off course. The issue with this theory, however, is that a clear definition of a proper tracking motion has not been established. In fact, many studies have found that every individual’s patellar tracking pattern may be distinct, and a normal movement path many not actually exist. A research study conducted in 2006 at Queen’s University in Canada discovered that there is no evidence to link aberrant patellar motion to knee pain. This means there is a good chance that if you assessed the patellar movement of healthy knees, you would see patterns similar to those in pathologic knees.
So, if the knee cap is not the culprit, then what is? Why has this pain occurred and where is it coming from? The answer is to look beyond the site of pain and assess the body as a whole. Currently, the gold standard treatment for this issue is to strengthen the vastus medialis, one of the muscles comprising the quadriceps. This is an effective treatment if weakness of this muscle is the legitimate cause of the pain. If it is not the cause, though, then improving the strength of it will do little to improve the situation. The practitioner should perform a comprehensive assessment of the lower limb; the foot, ankle, knee, and hip joints should all be assessed for subluxation and aberrant motion, and the muscles checked for hypertonicity and weakness. They should also be working to find which motions or regions of muscle reproduce, exacerbate, or relieve the knee pain. From here, a proper solution can be provided and an effective treatment plan can be developed. This may include initial reduced activity or a period of time away from sport, adjustments, stretching, instrument assisted soft tissue work (FAKTR, Graston), active release therapy, massage & resistance exercises.
The following are potential causes of PFPS:
- Weakness of the quadriceps muscles
- Tightness of the iliotibial (IT) band
- Inhibited or hypertonic gluteal muscles
- Hypertonicity of the quadriceps, hamstrings and/or calves
By Taylor Meyers