If you are struggling with sharp, consistent pain in the front of your knee or just underneath the kneecap that can cause you to have discomfort when:
-walking on grassy or uneven surfaces
-trying to go down the stairs (more than up)
-difficulty with getting up from a low chair height
… then keep reading below because you might be someone suffering from one of the most common causes of knee pain that we see in our clinic nearly every day: PFPS – Patella-Femoral Pain Syndrome.
As mentioned, patello-femoral (PF) joint pain is the most common cause of knee pain that we help people with in the clinic. The PF joint refers to your kneecap (the patella) gliding up and down within a shallow groove of your thigh bone (the femur). And there you have a patella-femoral joint 🙂
This joint is pretty easy to locate: start by sitting with your heel propped on the floor in front of you and straighten your leg with your muscles relaxed. You should be able to grip the sides of your kneecap and wiggle it from side to side when your muscles are relaxed. Now, if you tighten your quad muscles on the front of your thigh (think of pushing your knee fully straight), you should be able to feel this tightening on your kneecap so that you can no longer push it side to side.
This should give you an idea of how shallow the joint is and which muscle you now know controls this joint… which leads us to the problem and why pain is so common: since the joint is so shallow, it relies primarily on the muscles to stay in good alignment throughout the full motion of the knee.
As you bend and straighten your knee, your kneecap should stay in good alignment within the groove. When the alignment changes, due to many possibilities especially over a long period of time, you start to develop pain and irritation underneath or in front of the kneecap. This pain is amplified by more demanding activities, such as squatting down, going up and down stairs (especially down) and trying to stand up from a low chair.
Now that you can imagine what PF pain looks like, let’s make sure you know what CAUSES it. Because, what is the point in knowing a possible reason for your pain if you don’t know why it happened in the first place?
To keep this gliding, nearly free-floating joint happy, like we mentioned, proper muscular control is required to keep good alignment as the kneecap tracks up and down in its groove. One muscle to think about is the quadriceps, or the front thigh muscle (composed of 4 muscles total, thus “your quads”). Since this muscle encompasses the kneecap, it makes sense that having adequate control and strength is vital to the success of avoiding this pain.
Sounds really simple, right? To some extent, it is simple. But not quite… Just treating PF joint pain with quad strengthening will usually give you a good amount of pain relief.
But since the knee is right in the middle of your leg, you have to keep in mind that the alignment of the knee is directly affected by the joints above and below. If you ignore the alignment of the hip and the ankle, quad strengthening might not be enough. Throw in an imbalance of strength or flexibility between certain hip & knee muscles, some tightness in your IT band, and a fair amount of pain, and all of a sudden just strengthening the quads is no longer your #1 and only best solution.
But don’t let that get you down! I’m going to share a lot of helpful information with you about PF joint pain and knee pain in general that will allow you to start reducing your pain right away.
Here are a few helpful tips to get the ball rolling:
•Tip #1: Strengthen your quads and hips in a pain-free motion. My line: if it doesn’t recreate the same pain… keep going. If it does, consider changing the exercise.
• Tip #2: Look at your ankle joint and arch. If you have low arches, consider supporting them with inserts.
•Tip #3: Avoid painful activities temporarily, such as deep squatting in chairs, going up/down stairs constantly, and avoid the grassy or gravel areas.