My interest in patellofemoral pain syndrome (PFS) has increased given that I recently re-injured my knee as a result of some aggressive aerobic and weight training coupled with a particularly challenging hike involving steep uphill/downhill activity. Given that I am doing a 100 mile hiking trip (Tour du Mt Blanc) in several months, I have no time to lose in making sure I get better. Years ago I received treatment for PFS  brought on by running every day so I decided to investigate what, if anything, is new in treatment.

PFS is knee pain caused by a number of factors but essentially involves overuse/overload of the patella-femoral (knee/thigh) joint. Typical symptoms are knee pain with activity, especially descending stairs or hills, or popping or grinding pain of the knee with bending. Interestingly, pain can also occur as a result of prolonged sitting which increases the pressure on the patella (knee cap).

The patella is embedded in the quadriceps (thigh) tendons and when the thigh muscles contract, the patella is pulled into a shallow groove in the femoral bone. If the muscles are weak, the patella is misaligned, or there are certain structural problems, irritation and pain develop under the patella. Sometimes lack of flexible tendons and muscles also contribute to the misalignment which is why treatment often focuses on stretching and strengthening of all the major insertion points of the different muscle groups: hip flexors (the 6 muscles that enable you to lift your legs), quadriceps (4 major muscles of the anterior thigh), and the hamstrings (the 3 muscles behind the thigh which allow you to bend your knee).

Although most of what I found about treatment has not changed, I did come across one website called Sports Injury Info, that offers a slightly different approach. Barton Anderson is a certified athletic trainer who now teaches at A.T. Still University in Mesa, Arizona and he advocates core and hip strengthening and improving mobility of the hip flexors. A more traditional method involves quad strengthening that many sufferers of PFS will have had experience with. Barton Anderson offers a specific program to follow that I’ve decided to try. Many of the exercises and stretches that he advocates I’ve worked on with my personal trainer so I’m curious to see if by following the 4 stages in a programmed way will make a difference. Although it can be distracting, ignore the few spelling mistakes you’ll find – the quality of the information he offers is still very good.

For those who would like to see a series of slides that show how to safely stretch these muscle groups, the Mayo Clinic web site is your best bet. Finally, to learn more about PFS and treatment options, the American Family Physician magazine has a good article (although dated) outlining the causes and treatment options of PFS.