PATELLOFEMORAL PAIN SYNDROME
BACKGROUND, CAUSES, SYMPTOMS, AND MANAGEMENT
RICHARD A. CALLO, PTRP
Faculty, MMSU-Department of Physical Therapy
What is patellofemoral pain
syndrome?
• A condition characterized by pain
around or behind the kneecap
(patella)
• Often occurs due to overuse, muscle
imbalance, injury or problems with
the alignment of the patella within
the groove of the thigh bone (femur)
• Can result from activities that involve
repetitive knee motion, such as
running, squatting , or jumping
What is patellofemoral pain
syndrome?
• A condition characterized by pain
around or behind the kneecap
(patella)
• Often occurs due to overuse, muscle
imbalance, injury or problems with
the alignment of the patella within
the groove of the thigh bone (femur)
• Can result from activities that involve
repetitive knee motion, such as
running, squatting , or jumping
AGE AND GENDER
PREVALENCE
• most prevalent musculoskeletal • affects adolescents, young
disorders adults and athletes
• accounts for 25% of all • females > males
knee-related conditions
PREVALENCE AGE AND GENDER
• most prevalent musculoskeletal • affects adolescents, young
disorders adults and athletes
• accounts for 25% of all • females > males
knee-related conditions
PATELLO
FEMORAL
JOINT
• Patella articulates with
the intercondylar
(trochlear) groove on
the anterior aspect of
the distal portion of
the femur
Patellar
Function
• increase the
moment arm of the
quadriceps muscle
in its function to
extend the knee
Patellar
Alignment
Q-angle-formed by two
intersecting lines: one from the
ASIS to the midpatella and the
other from tibial tubercle
through the midpatella
Patellofemoral Pain
with Malalignment
or Biomechanical
Dysfunction
Broad Pelvis
Increased
Anteversion
Increased
Q-Angle
Patella Alta
Genu
Valgum
Subtalar
Pronation
Patellofemoral Pain
Without Malalignment
Plica Syndrome
• condition related to the irritation
of remnants of embryological
synovial tissue around the patella
Fat Pad Syndrome
• Irritation of the infrapatellar fat
pad from trauma or overuse
Tendonitis
• inflammation of the patellar or
quadricep’s tendon
• sometimes called jumper’s knee
Iliotibial Band
Friction Syndrome
• irritation of the IT band as it passes
over the lateral femoral condyle
Prepatellar Bursitis
• Result of prolonged kneeling or
recurrent minor trauma to the
anterior knee
Osteochondritis
Dissecans of the Patella
• pain on the retro surface of
the patella
Traumatic Patellar
Chondromalacia
• softening and fissuring of the
cartilaginous surface of the patella
Trauma
• includes tendon rupture, fracture,
contusion and articular damage
I
C M
P
O A
M I
R
M M
E
O N
T
N S
I
C M Pain on the retropatellar region
P
O A
M I
R
M M
E
O N
T
N S
I
C M Pain on the retropatellar region
P Pain along the patellar tendon or at the
O A subpatellar fat pads due to irritation
M I
R
M M
E
O N
T
N S
I
C M Pain on the retropatellar region
P Pain along the patellar tendon or at the
O A subpatellar fat pads due to irritation
M I
R
Patellar crepitus, swelling and locking of the
knee
M M
E
O N
T
N S
I
C M Pain on the retropatellar region
P Pain along the patellar tendon or at the
O A subpatellar fat pads due to irritation
M I
R
Patellar crepitus, swelling and locking of the
knee
M M Altered lower extremity alignment
E
O N
N T
S
I
C M Pain on the retropatellar region
P Pain along the patellar tendon or at the
O A subpatellar fat pads due to irritation
M I
R
Patellar crepitus, swelling and locking of the
knee
M M Altered lower extremity alignment
E
O N Weakness of hip abductor, external rotator and/or
T extensor muscles
N S
I
C M
P
O A
M I
R
M M
E
O N
T
N S
I
C M Weakness of the VMO muscle
P
O A
M I
R
M M
E
O N
T
N S
I
C M Weakness of the VMO muscle
P
O A Overstretched medial retinaculum
M I
R
M M
E
O N
T
N S
I
C M Weakness of the VMO muscle
P
O A Overstretched medial retinaculum
M I
R Restricted lateral retinaculum, IT band or
M M fascial structures around the patella
E
O N
T
N S
I
C M Weakness of the VMO muscle
P
O A Overstretched medial retinaculum
M I
R
Restricted lateral retinaculum, IT band or
fascial structures around the patella
M M
E Decreased medial gliding or medial
O N tipping of the patella
T
N S
ivity
ons and
pation
ctions
Activity
Limitations
and Limited Performance of Basic Activities of
Participation Daily Living (ADLs)
Restrictions
Activity
Limitations
and Poor-related limitations of functional
Participation mobility
Restrictions
Activity
Limitations
and Inability to maintain prolonged flexed
Participation
Restrictions
knee postures
P
R
O P
T H
E
C A
T S
I
O
E
N
P
R
O P
T H
E
C A Rest
T S
I
O
E
N
P
R
O P
T H
E
A Modalities
C
T S
I
O
E
N
P
R
O P
T H
E
C A Gentle Motion
T S
I
O
E
N
P
R
O P
T H
E Pain-free muscle setting exercise
C A
T S
I
O
E
N
P
R
O P
T H
E
C A Splinting
T S
I
O
E
N
Increase Flexibility of Restricting Tissues
Patellar Mobilization: Medial Glide
Medial Tipping of the Patella
Patellar Taping
Improve Muscle
Performance and
Neuromuscular
Control
TERMINAL KNEE EXTENSION EXERCISE
SQUAT EXERCISES
DYNAMIC EXERCISES
RESISTANCE EXERCISES
PLYOMETRIC EXERCISES
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