Knee Screens – Patellofemoral Syndrome
Bonnie is back to help and explain what Patellofemoral Syndrome is, and why as Pilates Therapists this could be a really valuable screen to have in your toolbox! If you haven’t already looked at our previous knee screens, we’d recommend you do so!
Just so you can familiarise yourself with the anatomical terms and palpation points used in this video! Links to the relevant recent videos can be found at the bottom of this post!
The term Patellofemoral Syndrome is quite a generic and broad term used to describe pain in the front of the knee and around the kneecap (patella)
You may hear it being referred to as “runner’s knee” or “jumper’s knee” because it’s common in people who do a lot in sports – particularly females and young adults. Having said that, Patellofemoral Syndrome can affect those who are not involved in sports, as well. Sometimes these conditions can be compounded by wearing the wrong type footwear. You’ll commonly find that people suffering with this pain and stiffness will struggle to climb stairs, kneel down, and perform similar other everyday activities.
Anatomically, the patella should sit in the groove between the condyles of the femur, facing straight forwards. However, when patellofemoral syndrome is present, the patella is pulled laterally, sitting outside of the normal groove. It’ll often grate or click over the femur and underlying structures which is what causes the pain.
So what causes it?
There are many things which may contribute to the development of Patellofemoral Syndrome.
Structural Leg Alignment is perhaps the most common attribute to Patellofemoral Syndrome. People with ‘knock knees’ will be more predisposed to conditions like this. Some literature states that women are more susceptible to conditions like this because their hips are wider than men’s – Meaning that the femurs (thigh bones) have more space to medially rotate and therefore predisposing knock knee or misalignment.
Foot Alignment is a large contributory factor. If the foot pronates, this means that the tibia/fibula medially rotates, causing the knee to roll in and then consequently the knee cap can sit laterally and predispose pain.
Hyper-Mobility is another factor which isn’t commonly looked at. Anyone who has the ability to stand with their knees locked back or hyper-extended is at an increased risk. People with hyper-mobility or similar conditions relating to hyper-mobility such as Ehlos Danlos Syndrome have varying degrees of laxity to their ligaments which means that the ligaments aren’t taught enough to prevent excessive movement. Therefore, if someone can hyper-extend their knees then this allows the patella (knee cap) to be drawn laterally.
Muscular Imbalances or Poor Stability can contribute to Patellofemoral Syndrome. Some muscles in the leg have a direct effect on the stability of the knee and if there’s an imbalance or a weakness then you can get a ‘push me, pull you’ situation going on…think of it like a game of tug of war!
Taking your quadriceps for example – Looking at the relationship between the Vastus Medialis and the Vastus Lateralis. If there is an imbalance here where one of these is stronger than the other or one is inhibiting the other then the positioning of the knee cap (patella) will be directly affected. If the Medialis is weak and the Lateralis is overworking, then it’s going to pull that knee cap laterally.
And let’s not forget the Gluteals…the Glute Medius not only helps to stabilise the pelvis but it also helps with lateral rotation of the leg. If this is weak then internal rotation becomes a lot easier to fall into. And then it can become a knock on effect, where the Glute Max and TFL tighten up to try to help stabilise the pelvis – The Glute Maximus and Tensor Fascia Latae insert into the Iliotibial Band which then inserts just below the knee so stabilisation of the knee is compromised if you have a muscular imbalance up the chain.
My client is positive in this screen, what do I do?
A positive reaction on this screen would typically result in pain when they try to extend their knee or recruit their quadricep. If that’s the case then it’s best you refer them to their GP or their physiotherapist. As Pilates Therapists, we do not diagnose nor replace the need for medical treatment of any kind. We are here to observe movement and support these practitioners.
Once your client has seen a medical practitioner and has been cleared for Pilates exercise, there are many things you can do to help and potentially improve their condition. We delve deeper into this on our Knee and Foot courses and we still have a few spaces free should you wish to join us and learn more! So if you’re interested, please feel free to visit our Courses page or why not drop us an email at email@example.com