Several anatomic and congenital factors may lead to a predisposition towards patellofemoral pain and/or instability. Tightness of the quadriceps muscles, hamstrings and iliotibial band, and relative weakness of the quadriceps muscle are probably the most common causes. Other factors that can contribute to this problem include femoral anteversion (excessive rotation of the hips), tibial torsion (excessive rotation of the shin bone), genu valgum (knock knees), genu recurvatum (hyperextended knee) and excessive pronation (flat feet).
How is patellofemoral pain treated?
Treatment for patellofemoral pain syndrome involves a combination of activity modification, anti-inflammatory modalities and a comprehensive stretching and strengthening program. Surgical intervention is rarely necessary and is generally reserved for cases of recalcitrant instability or symptomatic malalignment.
To the extent that patellofemoral symptoms are caused by a change in activity level, or exacerbated by specific activity, activity modification is the mainstay of treatment. Treatment of acute onset of patellofemoral pain syndrome from a specific event, such as running a marathon or initiating a new exercise program, is relatively straightforward. In general, this would involve an initial period of rest, ice, over-counter anti-inflammatories and a slow, gradual resumption of activities in a progressive manner.
Chronic, recalcitrant patellofemoral pain syndrome is much more difficult to treat. It can be a frustrating problem for physicians and patients alike. The mainstay of treatment for chronic patellofemoral pain syndrome is a combination of quadriceps strengthening exercises in addition to quadriceps, hamstring and iliotibial band stretching exercises. It is often helpful to refer patients to a physical therapist for one or two sessions of hands-on instruction in the appropriate exercise program. Occasionally, electric stimulation, biofeedback and McConnell taping techniques are useful. Prolonged physical therapy with modalities such as ultrasound is generally not helpful or cost effective. Orthotics to correct pes planus and soft braces with patellar cut-outs may be indicated and provide modest symptomatic relief in selected cases.