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Patello-femoral syndrome

I was recently diagnosed with patello-femoral syndrome. My right kneecap is laterally tracking to the right from a frontal X-ray of my right knee.
For those of you who know about or have experienced this condition, what sort of treatment/physical therapy were you given and how effective was it ?

From what i understand, lateral tracking can be caused from a tightness in the vastus lateralis and a weakness in the vastus medialis. Tightness in the lateral retinaculum and illotibial band can also cause the patella to track laterally. I think strengthening the vastus medialis would be your best bet. This can be done with Step ups and split squats first and then by progessing to full squats. Remember that the medialis is very active in the bottom portion of the squat so you might want to emphasize that portion, ie 1 1/3.

I have the problem and am currently almost over it. I have had the problem for over a year but in the last 6 weeks i have made more progress than the last year. A therapist will probably give you a variety of exercise to d(isometrics, 1/4 squats, leg extensions etc) the main thing is don’t aggravate the condition. Another thing that is of concern is “Why has this conditioned developed in the first place” In my case i didn’t figure it out until a few months ago, i had alway done all my leg work with a shoulder width or so stance. Lately i have been partial squating power lifting style. The progress i have made is remarkable-my medialus on my right knee(bad knee) almost is the same size again as the left and my knee is nearly pain free. Remember be sure to try some new things-my Physical Therapist never mentioned using wide stance-he also could never figure out why i never got better
good luck

I had it when I was a senior in college, and it did make it pretty painful to play football, but it was easily overcome. Before working out heat your knee, and ice afterward. It is caused by muscle imbalances, so try to strengthen your quads and all the muscles surrounding you knee. It will probally hurt quit a bit, but it will make your problem go away. Also try to use some type of anti-inflammatory.

well, all the doctor did for me was to tell me to get a pair of orthodics because i overpronate while walking.
he also told me to do isometric quadricept contractions, ie. put 3 pound weight on ankle, raise leg foward 60 degrees and lower. not much else was perscribed.

I had a mild case of it and my family doctor is also an excellent sports doctor. He said that for me, it was caused by doing primarily powerlifting stance squats so my outside quad was far stronger than the teardrop. You could tell simply by looking. He did some tests and he was able to duplicate the pain and said that basically the outside quad was pulling the cap over to the side (I only had the problem when doing heavy full squats). He said while propping myself up on the elbows, do as many sets of 10 of leg raises, circles one way, then the other and T’s (up, left right, down) as I can. I also used a hack squat machine and exaggerated the excercize. I put my feet about 10" apart and so that my toes were hanging over the platform edge. I did these bottoming out on the machine. Not only did the pain stop but my squat got stronger quickly.

I also wore a knee brace with the L shaped insert to push the cap over while I squatted until the pain went away.

Chris, check the length of your quads: lie prone (face down) on the floor, with your head down and relaxed. You relax as your partner bends your right knee. Ideally, you should be able to touch the heel to the butt on the same side. Short quads can lead to a condition called Patella Alta, which means that the kneecap rides higher than it should, causing undue wear and tear when it flexes under load. My experience is that about 70% of all people with PFPS can achieve significant cessation of symptoms through quad stretching. Best of luck…

Orthotics if they are needed is the first step. Find a good podiatrist/orthotist. Secondly, stretch the hell out of your quads hams hip flexors ITB & piriformis every day. Note the right left differences and emphasize stretches accordingly. Deep squatting with a slightly wider than shoulder width stance toe out slightly is your best bet with a slow controlled motion through the bottom portion. I find the split squat tends to emphasize the lateralis and glute (where do you feel it?) so I would not recommend that movement. Step ups are good especially if your up leg is adducting on the concentric portion of the lift due to greater medialis involvement. In the early stages of rehab ice after the fact to reduce inflamation, NSAIDS wouldn’t hurt either.

How would you suggest stretching the ITB and piriformis ?

You check into McConnell taping, a technique that entails using tape to position the patella so that it tracks through the trochlear groove without making contact with the femur.

The theory is that sometimes patello-femoral syndrome results from a miscoordination of the vastus medialis and the vastus lateralis (the quadriceps muscles on the inside and outside of the leg, respectively) so that one muscle contracts too much and pulls the patella to one side. After such taping on a daily basis for a time, the nervous system recalibrates the balance between the medialis and lateralis muscles and taping may be discontinued.

The reason the taping is necessary, so they surmise, is that once the mistracking produces pain, the nervous system sort of “freaks out” and cannot recalibrate itself for proper tracking, so the taping eliminates the pain long enough for the nervous system to make the needed corrections without the inhibitions induced by pain.

I'm afraid I cannot comment much more on this as I don't work in sports medicine and the one time I used this technique was seven years ago on a patient I didn't get to follow up with. My understanding is, though, that the taping should only last a short time, i.e. less than three weeks, though I dimly recollect some people only needing five days of taping, but don't quote me on any of this--I'm no expert!

If I were you, I’d call around to some outpatient physical therapy clinics and find someone who is expert in the sports side of things and ask about this technique. Perhaps this technique is no longer in vogue or has been surpassed by something else. I would think that after a couple of sessions with the therapist, you would know how to do the taping yourself or could have a friend trained to do it to you. It isn’t hard. And do anything else recommended by the PT. Stretching the quads and ITB is definitely something to do whether you do the taping or not; you want a permanent solution and stretching is part of it.

I hope that helps. Please let me know what you find out. I’ll talk to my sports medicine buddies and see if they have anything else that might help.

oh yea i guess i should mention that i stand and squad (without weights, just normally day to day stuff) in a weird stance. When i stand my feet are usually at a 90 degree angle and when i squat my hips are too. i figure this might be contributing to my problem. Perhaps the external rotators of my hips are too strong?