Patellofemoral Joint Syndrome

Patellofemoral Joint Syndrome (PFJS) is a condition that I see regularly, especially in female triathletes.
PFJS pain generally appears at the front or 'deep' within the knee joint that occurs during certain movements such as deep lunges, squats, running at intensity, climbing stairs, going uphill or during cycling.

Put simply, it occurs when the Patella (the kneecap) is not sliding with its groove along the Femur.  There can be many causes for this, but this condition will often be caused by tight or over worked Hip Flexor muscles, Glutes or a tight Iliotibial Band (ITB).  A visit to a Physiotherapist is generally the best first step if you feel you are experiencing PFJS.  A Physiotherapist will be able to figure out which muscle group is causing the patella to shift across and not slide within its groove properly and give you the appropriate management to fix it.

So what role can a Sports Podiatrist play in fixing knee pain??

A recent systematic review conducted by the British Journal of Sports Medicine found that a combination of; correcting foot biomechanics and an exercise therapy based treatment was the most effective way in reducing PFJS pain.

As a Sports Podiatrist, we are able to establish the affect the mechanics of your feet have on your knee joint.  If your foot mechanics are poor, this can be potentially causing extreme loading through your knee, causing it to roll inwards excessively under high load (such as riding a heavy gear or running up a hill) and causing the Patella to shift sideways.

PFJS is commonly caused over a long period of time and can be characterised by:

Pain when squatting, lunging or exercising at a high intensity
In every day life such as going up or down stairs
Pain commonly occurs after physical activity in its early stages
Minor swelling at the front or below the Patella
Mild pain and stiffness when getting up after resting for a long period of time

Treatment of PFJS can vary, but some common treatment modalities include:

Visit to a Physiotherapist for some soft tissue release and rehab of weak muscle groups
Foam roller along your ITB (may need a towel to bite on when doing this!!!)
Visit to a Podiatrist to establish if the foot is affecting the mechanics within the knee joint
Use of correct footwear or orthotics to correct foot or knee mechanics (remember shoes don't always mean best)
Temporary taping of the joint to align the Patella to the Femur
Assessment of your running gait and bike fit
Use of custom cycling inner soles to reduce loading through the knees when riding
Wearing of compression garments post exercise to reduce swelling with the knee
Ice Compression Elevation if pain and swelling are present within the knee post exercise

So if you think you're experiencing PFJS, be sure to book an appointment with your local podiatrist.

Ryan Twist is a Sports Podiatrist practising out of Bayswater Foot and Ankle Clinic in Melbourne's outer east. He founded the clinic 5 years ago after returning home from working at Sports Podiatry Clinic in Canberra, where he gained valuable experience working with athletes at the Australian Institute of Sport. He has a passion for triathlons having competed in 7 Ironman’s and 10 Half Ironman’s - and qualifying for the World Ironman Championships in Hawaii. Some may say he is crazy, but let's not tell him that!

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