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Patellofemoral Pain Syndrome

I’ve been seeing a lot of people with pain in the front of the knee, worse with stairs and hills, mostly women, all classic findings of patellofemoral pain syndrome. Easy to diagnose, hard to treat. So what exactly is it and what causes it? No one knows for sure, though there are a bunch of theories.


The most common theories include overuse & overload (runners), biomechanical problems (flatfoot or high arch), and muscle imbalance (seen more in women). Treatment almost always involves physical therapy for quadriceps strengthening, especially the inner quad. The misconception is that the kneecap only moves up and down, when in fact it also moves “side-to-side.” Thus, strengthening the inner quad helps to provide a more “neutral” alignment of the kneecap.


Other forms of treatment include rest, ice, & anti-inflammatories, all of which may help relieve pain, but not alter the actual condition. In rare instances, surgery may be warranted to help align the kneecap a bit better, but this should be reserved for extreme situations when nonoperative management has failed.


I have recently started treating these with visco-supplementation injections (rooster comb shots like Synvisc) followed by a long course of therapy. I also recently learned of a brace that seems to help stabilize the kneecap better than the traditional knee sleeves. A colleague of mine has been using this for quite some time and most of his patients really think it helps. The downside is that it is a custom brace and is definitely bigger than a typical knee sleeve. But if it helps get rid of your pain and allow you to do the things you want to do….check out some more info on this brace at http://bledsoebrace.com/products/2050.asp



I would always recommend as much PT as possible, in conjunction with injections and the brace before considering any of the surgeries now. I have seen too many people not respond too favorably with surgery


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