Member Case Study: Patellofemoral Pain Syndrome

author : AMSSM

comments : 0

I have a very annoying pain under my knee cap. It does not hurt when I run or ride. It hurts a lot when I swim and when I walk up or down stairs. The pain is a searing pain. Help!

Member Question from Malgal

I have a very annoying pain under my knee cap. It does not hurt when I run or ride. It hurts a lot when I swim and when I walk up or down stairs. The pain is a searing pain. Could this be runner's knee? It can disappear for weeks on end. Today it flared up while I was doing house work! I always knew that house work was bad for me. It bothered me a bit during the swim of my first tri this summer but not at all in the second one which was only a couple of weeks ago. If I weight bear on it going up stairs, my leg can almost give way from under me and it hurts - a lot.

Answer from Srinivas Ganesh, MD

Member AMSSM

Your symptoms sound consistent with runner's knee or patellofemoral pain syndrome (PFPS). This pain can be intermittent in nature and present in multiple forms including a "searing" type pain with clicking or grinding that is felt behind or around the kneecap. You may also experience a buckling of the knee due to a temporary spasm of the supporting muscles. Though activities such as running and cycling are more common causes, swimming or performing housework that involves a lot of squatting or kneeling on the knees can aggravate this condition.

Therefore, avoiding or modifying activities that are known irritants is important. Also, if you are not an experienced swimmer, have a swim coach assess your form and make sure that you are not excessively using your knees for propulsion.

Other factors that increase the risk of developing PFPS include anatomic abnormalities and muscle imbalances. A simple test to help assess whether you are predisposed to this condition is to perform a single leg squat in front of a mirror. People whose knees tend to dive medially (towards the middle) as they squat down tend to have weak quadriceps muscles and poor core stability. A physical therapist can help guide you through a series of exercises and stretches to address these issues.

Also, you may find that your iliotibial band has become tighter from running. When this happens, your kneecap gets pulled laterally and out of its groove. Use of a foam roller can help reduce the tension and help maintain the kneecap's alignment. Another consideration is if you have a tendency to overpronate or have low arches. If so, you may want to consider running shoes that provide extra support such as motion control or stability shoes, or the use of orthotic inserts.

PFPS is a condition that you control but don't cure. Keep in mind the importance of listening to your body’s signals and resting it when it needs it. Ice sore areas after workouts and don't be afraid to take a day off from your exercise regimen to let your body and mind recover.

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date: December 28, 2009