Patellofemoral Treatment Downtown Toronto Podiatrist and Physiotherapist
Patellofemoral Pain Syndrome is a term that has to do with the pain on the femoral and patella joint. It can have pain diffuse all around the knee, the soft tissue structures, tendons and fascia. Pain can even be found behind the knee! Pain is typically found during squatting, sitting, climbing stairs, and running.
Runners and cross country skiers can be prone to this condition. In fact, it is sometimes called
” runners knee”. Here at Instride, our chiropodist is a runner and would love to help you with this condition. At InStride, we treat patellofemoral and runners knee in Downtown Toronto via our Podiatrist, Physiotherapist and Chiropodist.
Causes of Patellofemoral Pain
A combination of several factors (multifactorial causes): overuse and overload of the patellofemoral joint, anatomical or biomechanical abnormalities, muscular weakness, imbalance or dysfunction.
The condition has to do with how the kneecap (patella) tracks/ moves during movement. When there are imbalances this can cause the tracking of the kneecap to deviate from the norm. Muscular imbalances or biomechanical abnormality can cause a patellar deviation and also provoke PFPS.
When the Vastus Medialis Obliquus (your inside quad muscle) isn’t strong enough, the Vastus Lateralis can exert a higher force and can cause a lateral glide, lateral tilt or lateral rotation of the patella (your knee cap), which can cause an overuse of the lateral side and result in pain or discomfort.
Another muscle and ligament that can cause a patellar deviation is the iliotibial band or the lateral retinaculum in case there is an imbalance or weakness in one of these structures. Weak glute medius can cause a tight IT band, so that is why addressing glute strength and mobility is also important.
How are feet contribute to Patellofemoral Syndrome
Sometimes the pain and discomfort is localized in the knee, but the source of the problem is somewhere else. Pes planus (flat feet /pronation) or Pes Cavus (high arches/ supination) can provoke PFPS. Foot pronation (which is more common with PFPS) causes a compensatory internal rotation of the tibia or femur that upsets the patellofemoral mechanism. Foot supination provides less cushioning for the leg when it strikes the ground so more stress is placed on the patellofemoral mechanism. At InStride, our Downtown Toronto Podiatrist and Downtown Toronto Physiotherapist can help determine if feet are contributing to your knee pain.
Treatment
Like any injury, it is best to avoid provocative load. That means any exercise that aggravates the pain. Usually going up hill or up stairs is fine, but going downstairs and downhill can be problematic. Cross training helps to maintain fitness while you rehabilitate the condition.
Strength!
Squats done with squeezing a ball between your thighs can help train your body to keep alignment and strengthen proper form.
12 reps 3 sets is recommended. If you find the ball tends to slip, wrapping a theraband around it helps to provide grip and traction.
Single Leg Glute Bridge
Hold 45 sec x 4 -5
Heel Downs
This exercise may be painful for some. So a little goes a long way. YOU DO NOT have to go full range. In the start baby steps by slightly lowering, so you feel the activation is enough. Make sure the knee does not buckle inwards
12 resp 3 setsS
Single leg banded deadlifts
12 reps 3 set. Making sure to hip hinge. If you do not know what this is please familiarize yourself with it
Stretches and Mobility
Quadrecepts Foam Rolling and Stretching
Glute Medius stretching
Foot Orthoses
There are a few clinical predictors that can help decide if a patient is more likely to benefit from foot orthoses or not. Studies have been found to assess if orthotics help patellofemoral pain. One way to assess is to test by doing a single leg squat without an orthotic. Then retest with an orthotic on. If there is found to be a decrease in pain during the movement. It will be a sign orthotics can help.
Foot orthoses significantly enhanced functional performance in individuals with PFPS after 12 weeks, and these improvements were greater than those observed immediately after the foot orthoses were used.
We can examine and fit orthotics for those deemed necessary and suitable at Downtown Toronto Podiatrist and Chiropodist and Physiotherapist in our Instride Clinic.
