Giving Patellar Pain a One-Two PunchEver hear of PFPS? Sounds like someone whispering to get your attention. Patellofemoral pain syndrome (PFPS) is anything but a whisper coming from the knee. Pain around or under the kneecap gets patients' attention loudly and clearly. Climbing stairs, sitting for long periods, squatting, and kneeling are especially painful activities.
PFPS is somewhat of a mystery. Actual problems or disease are rarely found. It may be caused by the kneecap (patella) getting off track as it goes up and down during knee motion. Recent studies show that it might be a problem with muscle control rather than muscle strength.
The leg straightens and the patella moves up when the quadriceps muscle is contracted. This large muscle of the upper thigh is divided into four parts. Two of those sections are most important for knee extension. These are the vastus medialis oblique (VMO) and the vastus lateralis (VL).
Physical therapists are working hard to find ways to treat PFPS. Their focus is to retrain the muscles to contract with the correct timing. This is called muscle reeducation. Treatment includes taping the patella and doing exercises with biofeedback. This is called the McConnell Program.
Two groups of PFPS patients were included in the study. One group received the McConnell-based program, while the second group was the placebo group. Each group was treated once a week for six weeks. Home exercises without biofeedback were also done daily. The placebo group received "dummy" treatment.
Physical therapy improved patient's pain and function. According to this study, muscle control can be changed with retraining biofeedback. The placebo group showed no change in symptoms or function.
It's not clear which part of the treatment made the difference. Did the taping change the timing of the contracting muscles? Or did using biofeedback decrease the pain, so the muscles could then function normally? More research is needed to study each treatment step one by one.
Sallie M. Cowan, et al. Physical Therapy Alters Recruitment of the Vasti in Patellofemoral Pain Syndrome. In Medicine & Science in Sports & Exercise. December 2002. Vol. 34. No. 12. Pp. 1879-1885.
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