The tenth episode of the Sky Sport Doctor series, airing on Sky Sport, is dedicated to patellofemoral pain syndrome, commonly referred to as ‘knee pain.’ A very high percentage of knee pain cases occur among young people, and these episodes are quite frequent. Dr. Francesco Della Villa, Director of our Education and Research Department, explains what we can do to prevent this discomfort.
What do we mean by Patellofemoral Pain Syndrome?
Patellofemoral Pain Syndrome is one of the most common causes of anterior knee pain. It is a functional condition characterized by an imbalance in the patellofemoral joint, which connects the kneecap to the underlying femur. This joint is part of the knee, and its function relies on a delicate functional balance involving the smooth movement of the kneecap over the femur beneath it.
The pain, often bilateral, is located beneath or around the kneecap and is exacerbated by specific activities such as squatting, prolonged sitting, or descending stairs (one of the most characteristic symptoms overall).
The progression of the pain is inconsistent, often with periods of discomfort alternating with long stretches of well-being and complete absence of symptoms.
At the time of diagnosis, the patient has typically been experiencing pain for years.
How common is it, and who is most at risk?
Patellofemoral pain is considered the lower limb’s equivalent of back pain precisely because it is so common.
- Each year, approximately 30% of the active young population reports symptoms of patellofemoral pain.
- Approximately 40% of active individuals experience at least one painful episode during their lifetime.
Adolescents and women, particularly young girls, are at greater risk, as are those who engage in sports involving jumping and changes of direction (such as volleyball, basketball, or soccer) or activities that place significant stress on the knee, such as cycling and, to a lesser extent, running.
What are the causes of patellofemoral pain?
There are various presentations of patellofemoral pain, but this condition is caused by a combination of biomechanical factors (proximal, local, and distal) that work together to destabilize the lower limb.
The knee becomes a victim of what happens upstream (at the hip level) and downstream (at the ankle level), with the patellofemoral joint being the structure most affected.
At the hip level, we often observe excessive internal rotation and adduction of the femur, while at the foot level, a pronated rearfoot (dynamic flatfoot) is frequently seen. These two factors contribute to dynamic knee valgus, where the knee ‘collapses’ inward, forcing the patella to ‘misfunction,’ often pressing excessively outward.
These patients often place greater load on the knee, causing excessive pressure on the joint. The combination of factors leads to excessive stress on the patellofemoral joint, which, over time, can result in cartilage damage and patellofemoral osteoarthritis. This is why it is crucial to take action promptly.
How is Patellofemoral Pain Syndrome diagnosed?
The diagnosis is generally clinical, based on a sports medicine evaluation (with a characteristic medical history) and supported by an MRI scan (not always necessary but useful for ruling out other causes of anterior knee pain when clinical suspicion is present).
What does the treatment involve?
The treatment of Patellofemoral Pain Syndrome is primarily based on a functional recovery program focused mainly on exercise.
The two key objectives are symptom management and addressing the underlying causes (biomechanical predisposing factors) to ensure long-term results. Eliminating the pain is not enough because, if the individual returns to the same functional context, the pain will recur.
- The approach is based on muscle strengthening (hip, knee, and ankle), optimizing movement quality (of the entire body), and achieving an optimal progression of load.
- The duration of the treatment is no less than 2 months.
The process is divided into three fundamental parts.
- In patients with severe pain, the process begins in the gym. An initial pain management strategy (at the physician’s discretion) will be followed by flexibility exercises and strengthening of the knee and hip muscles.
- Once some strength has been regained, the patient can undergo a movement analysis test, a key step in the treatment. This test is useful for personalizing a program to optimize dynamic postures during sports activities.
- Patients with milder pain, who typically continue to play sports, can start directly at this stage.
- In this phase, biomechanical risk factors are addressed by focusing on movement quality. Movement is broken down into its simplest components and correctly reconstructed. This is the key phase of the treatment, culminating in control tests to objectively assess the state of recovery.
- The process concludes with on-field rehabilitation, aimed at recovering sport-specific movements in a controlled environment, before the long-awaited return to activity.
Isn’t this perhaps a bit too much for just some knee pain?
No, the process is demanding, but it is the best solution to break a dangerous vicious cycle and to maintain sports participation, which is key to safeguarding long-term health.
