A look at patellofemoral pain syndrome.

The Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT) is the first hospital-based facility dedicated to the study of sports medicine in the country. It was established by James Nicholas, MD, at Lenox Hill Hospital in New York City in 1973. The goal of the NISMAT physical therapy clinic is to return the injured professional and recreational athlete to his or her chosen sport or exercise. On the excellent NISMAT website, detailed information on various common sports injuries can be accessed (www.nismat.org). Here we take a close look at an extremely common condition in runners: patellofemoral pain syndrome.

Common manifestations of this pain include pain while squatting, sitting in a car or movie theater for long periods, or going up and down stairs. NISMAT reports that some 2.5 million Americans experience this pain, which refers to the joint between the kneecap (patella) and thigh bone (femur). Though it can appear due to malalignment of the patella and femur or from tight structures on the outside of the knee, it often results from weak quadriceps muscles in combination with the stress running creates on the joint.

When people bemoan the loss of the ability to run as they did in, say, college due to knee pain, they often simply need to strengthen their quadriceps muscles (see the strengthening exercises discussed below). The quads are important muscles that support the joint that otherwise takes the brunt of the impact stress due to running.

Patellofemoral pain may be felt behind or around the kneecap, or the knee may feel like it gives way at random. Mild swelling can occur around the knee. Sometimes the knee will make grinding noises upon bending or straightening. The primary goals of rehabilitation from patellofemoral pain syndrome are to re-establish motion, power, and stability to the joint. Often stretching and strengthening are sufficient to alleviate this condition. Be careful not to increase your mileage too quickly, as this is often the cause of and/or reason for exacerbation of the problem. As is often noted, generally, to run safe and injury free, you should not increase weekly mileage by more than 10 percent.

Nonsteroidal anti-inflammatory medication, whether over-the-counter or prescribed, can help decrease the discomfort due to patellofemoral pain syndrome. Consult your doctor before beginning regular use of these drugs. To decrease pain immediately, ice packs can help; a heating pad is beneficial when your symptoms are less acute. Do not apply these treatments for longer than ten-minute sessions.

The following exercises will help you strengthen the muscles in the affected area, taking pressure off the kneecap:

Straight leg raises:

Lying on your back, bend the unaffected knee to stabilize the back. Contract the quadriceps in the affected leg and raise to the level of the bent knee. Hold for a count of one and bring the leg back down. Perform 3 sets of 15 repetitions. You can use an ankle weight to increase your muscle strength as you progress with this and other exercises in this series. A rule of thumb is to begin conservatively with weights equivalent to 20 percent of your body weight.

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Hip abduction:

Lay on your side with the affected leg kept straight and facing the ceiling. The bottom leg is bent. Keeping the top leg straight, bring your foot toward the ceiling, hold for a count of one, then return the foot. Do not bend your body at the hip. Do not allow your body to roll toward the stomach or back. Perform 3 sets of 15 repetitions.

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Hip adduction:

Laying on your side, place your affected leg on the bottom. Bend the top leg and keep it behind or in front of the straight leg. Raise the bottom leg and hold for a count of one before returning it to the starting position. Perform 3 sets of 15 repetitions.

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Hip flexion:

Sit at the edge of a table or chair, back straight and knees flexed. Bring the affected knee toward the ceiling. Hold the leg in this position for a count of one and then return to the starting position. You can use your hands for support on the surface, but do not lean forward or backward. Perform 3 sets of 15 repetitions.

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In addition to these strengthening exercises, perform the usual hamstring, quadriceps, iliotibial band, and calf muscle stretches after warming up, during cooldown, and throughout the day. Remember to never bounce when you stretch.

(NISMAT Physical Therapy Corner: Patellofemoral Pain Syndrome, 2005, The Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital, www.nismat.org)