Running Head: PATELLOFEMORAL DYSFUNCTION 1

Patellofemoral Dysfunction

Bryttni D Pugh

University of North Carolina at Charlotte

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Patellofemoral Dysfunction

Patellofemoral dysfunction or patellofemoral pain syndrome is an extensor mechanism

injury in which pain is felt at the front of the knee, and around or under the kneecap. One with

this dysfunction may experience general anterior knee pain, discomfort, weakness, and/or

swelling when exercising, participating in activities that involve repetitive knee flexion, sitting

for an extended amount of time, and going up and down stairs; popping in the knee and a

grinding or creaking sensation is possible during these activities (Clippinger, 2007).

Accompanying general physical activity, other causes include overuse, direct trauma to

the patella, patellar misalignment, structural abnormalities, and lack of muscular strength

(Hettrich, 2015). One can stress out the knee by doing intense physical activities that require

plenty of knee flexion like in dance and track. Young persons and athletes are most commonly

diagnosed with this injury. If one falls or has a direct blow to the knee, not only could the patella

be fractured or broken, but the direct trauma is now a risk factor. On the other hand, one may

have patellae that are out of place of the femoral, or trochlear, groove, causing irritation. His or

her patellae are pushed out to one side of the groove when the knee is bent due to poor

structural alignment of his or her legs and/or lack of muscular strength in the quadriceps

(Hettrich, 2015). Other structural factors that stress the patellofemoral joint are pes planus, or flat

feet, and pes cavus, or high-arched feet; pronation causes internal femoral or tibial rotation, and

supination does not provide much of a buffer for the legs (Juhn, 1999).

As for musculature, a tightness or weakness in the calves, hamstrings, hips, or iliotibial

bands can contribute to PFPS (Juhn, 1999). However, the strength or lack thereof in the

quadriceps is the most essential contribution because the patellofemoral joint allows the

quadriceps to lengthen and the contact area between the femur and patellar tendon to increase.
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The Q angle, the measurement from the anterior superior iliac spine through the mid patella to

the tibial tubercle, is responsible for shifting the patella laterally as the angle increases.

Therefore, women are predisposed to PFPS as a result of their wide hips a Q angle of ten to

nineteen degrees (Green, 2005). These causes and risk factors induce pressure or imbalance

within the patellofemoral structure.

The patellofemoral joint is comprised of several complicated structures due to its large

size. Above the patella there are the rectus femoris, vastus lateralis, vastus medialis, sartorius,

iliotibial band, and quadriceps tendon. Around the patella there are the medial patellar

retinaculum, lateral patellofemoral ligament, medial patellofemoral ligament, lateral patellar

retinaculum, capsule of knee joint, lateral patellotibial ligament, and medial patellotibial

ligament. Below the patella are the patellar tendon, fibula, tibial tuberosity, and tibia (Clippinger,

2007). The dysfunction primarily affects the patella, tibia, and femur, accompanied with the

quadriceps muscle, retinaculum, and patellar tendon; the retinaculum is a thin tissue that

connects the sides of the patella to the femur, and the patellar tendon connects the patella to the

tibia (Patellofemoral Pain Syndrome | Department of Orthopaedic Surgery, 2015). More

severely, the articular cartilage on the posterior side of the patella can be damaged and result in

chondromalacia patella, a specialized type of patellofemoral pain syndrome (Hettrich, 2015).

If one is unsure about whether or not he or she has a form of PFPS, the doctor will assist

him or her and perform a physical exam to pinpoint the location of the pain he or she is

experiencing. The doctor will examine the patella for swelling, instability, and tenderness; he or

she may wish to do a radiograph to check the alignment of patella in the femoral groove or an

MRI to check for damaged cartilage (Patellofemoral Pain Syndrome | Department of

Orthopaedic Surgery, 2015).

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Fortunately, patellofemoral dysfunction is common enough to be treated at home. One

could see improvements if he or she discontinues or reduces the amount of physical activity that

initially caused the stress, rests and ices the patella area, uses pain relievers like ibuprofen, and/or

wears shoe inserts. The RICE method is a home remedy that may help reduce any pain he or she

is experiencing: rest, ice for at least twenty minutes, compress the knee in a bandage, and elevate

the knee higher than the heart (Hettrich, 2015). Certain exercises are recommended to help

reduce the anterior knee pain like wall slides and straight leg raises. Most exercises will activate

specific parts of the leg to reduce the pressure on the knees and to strengthen specific muscles

including the quadriceps, hamstrings, calves, hip abductors/adductors, and iliotibial bands. Here

are some quick example exercises that one can repeat at least five to ten times each:

Quadriceps: On the ground, straighten one leg at a time for twenty seconds each then

release. Do straight leg lifts for ten seconds each.

Hamstrings: On the ground, bend one knee and grip your thigh. Bend and stretch for ten

seconds.

Calves: Do lunges (also activates hamstrings and hip flexors) and a runners stretch for

twenty seconds.

Hips: Sitting down, squeeze your hands or a ball between your knees. With a resistance

band, open your knees as much as you can like a clamshell. Standing up, bend one knee at least

thirty degrees and relev.

Iliotibial bands: On the ground, straighten one leg and bend the other while twisting the

torso and pushing on the bent leg for twenty seconds. Standing up, cross your legs and reach for

your toes for twenty seconds (Patellofemoral Pain Syndrome, 1999).

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If none of these treatments work, then surgery is an option and last resort. Surgeons can

transfer the tibial tubercle, loosen the lateral retinaculum tendon, or remove the softened or

damaged cartilage (Hettrich, 2015).

As a dancer diagnosed with patellofemoral dysfunction a few years ago, executing a demi

or grand pli comfortably is difficult to accomplish. Additionally, landing jumps and keeping my

legs straightened for an extensive amount of time is uncomfortable. If I engage the muscles

within my legs and then relax, I will feel and hear an intense pop. The sensation feels like I am

twisting my kneecap and tibia in opposite directions or similar to knee buckling with less pain. I

have discomfort with prolonged sitting or knee flexion; getting up out of a seat or off of the

ground takes a little longer to adjust to. I need to constantly stretch out my legs or move, so my

knees do not become stiff. I have the impression that I have aged quite a few years, but I

associate with certain causes and risk factors: being female, being a dancer, and having direct

trauma to the patella. Unfortunately, I slipped and fell while walking up the stairs, and I hit the

left kneecap on the edge of a hardwood stair and the right kneecap on the surface of another.

This resulted in pain and a slight bend in my left patella perhaps due to a possible fracture or

Wolffs law. Either way, I visited the doctor and discovered that my patellae groan and are weak.

Strengthening exercises directed towards my quadriceps were shown to me to take away the

stress from my knees.

Recently I have been participating in dance and yoga nearly every day, a dramatic shift in

exercise for me. This could have negatively affected my knees because PFPS can worsen with

intense exercise. However, my quadriceps and surrounding muscles are being activated and

strengthened throughout dance class, especially ballet. Although I have noticed worsening within

my PFPS, I must continue to follow the recommended treatments; if the condition begins to feel
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better, I need to take preventative actions to avoid any reoccurrence: maintaining a healthy

weight, wearing appropriate shoes, reducing physical activity then gradually increase the

intensity, warming up properly with flexibility exercises, and stretching before and after physical

activity (Hettrich, 2015).

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Test Questions

1. What kind of injury is PFPS?

a. Extensor mechanism

2. What type of PFPS is described as damage to the articular cartilage on the posterior side

of the patella?

a. Chondromalacia

3. Which muscle(s) need(s) to be strengthened the most in order to reduce anterior knee

pain?

a. Quadriceps
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References

Clippinger, K. (2007). In Dance anatomy and kinesiology (pp. 289-291). Champaign, IL: Human

Kinetics.

Green, S. (2005). Patellofemoral syndrome. Journal of Bodywork and Movement Therapies,

9(1), 16-26.

Hettrich, C. (2015, February 1). Patellofemoral Pain Syndrome-OrthoInfo - AAOS. Retrieved

March 16, 2015, from http://orthoinfo.aaos.org/topic.cfm?topic=A00680

Juhn, M. (1999, November 1). Patellofemoral Pain Syndrome: A Review and Guidelines for

Treatment. Retrieved March 17, 2015, from

http://www.aafp.org/afp/1999/1101/p2012.html

Patellofemoral Pain Syndrome. (1999, November 1). Retrieved April 12, 2015, from

http://www.aafp.org/afp/1999/1101/p2019.html

Patellofemoral Pain Syndrome | Department of Orthopaedic Surgery. (2015). Retrieved April 12,

2015, from http://orthosurg.ucsf.edu/patient-care/divisions/sports-

medicine/conditions/knee/patellofemoral-pain-syndrome/