The patellofemoral joint is the space between the kneecap and the long bone of the thigh, the femur. The space between these bones can become painful and injured for many different reasons. The kneecap can be dislocated, the cartilage under the kneecap can become softened and roughened (chondromalacia patella), or the joint space can be seemingly misaligned and cause pain. Traditionally, patellofemoral pain syndrome referred to an often overuse situation caused by poor biomechanics, tightened muscles laterally, weak muscles on the inside of the knee or overpronation in the foot (collapsed arches) to name a few. There is a rather long list of potential causative factors for patellofemoral pain syndrome and various theories as to how it happens and what can help. More recently there has been literature linking the hip and hip dysfunction to this condition. Thankfully, the research continues, and we’re learning more and more about how to effectively treat this condition.
Patellofemoral pain syndrome
Patellofemoral pain syndrome usually involves pain around the front of the knee. Imaging is usually not necessary as the diagnosis can be made through a careful conversation with the patient as well as physical tests. Patellofemoral pain can affect people of all ages. An interesting study published in the Journal of Orthopaedic & Sports Physical Therapy used the following criteria to determine those subjects who had patellofemoral pain; pain with squatting, prolonged sitting, stair ascent, stair descent, kneeling, or isometric quadriceps contraction.
What the research suggests
Being a chiropractor, I’m always interested to read new literature that investigates the benefits of spinal manipulation. As my patients know, I believe in using this treatment approach judiciously when there is some level of scientific evidence to support the idea. Usually, manipulation of the spine is considered for the benefit of conditions related to the spine and pelvis. Interestingly, some research now suggests that it may assist with patellofemoral pain syndrome! Several studies have found a relationship between chiropractic manipulation of the sacroiliac joint and lumbar spine and the quadriceps muscle (on the front of your thigh). These studies have linked this treatment to increased strength and reduced inhibition of this muscle. The aforementioned study in the Journal of Orthopaedic & Sports Physical Therapy looked further into this relationship and sought to decipher the criteria that might help practitioners identify which patients with this type of knee pain might benefit from spinal manipulation (chiropractic adjusting).
Fifty patients with patellofemoral pain were included in the study. Each of the patients had a supine lumbopelvic manipulation and were then re-examined using functional tests and pain questionnaires. Twenty-two patients were considered a successful treatment, reducing the pain in the patellofemoral joint. So, what does this tell us? What it doesn’t necessarily tell us is that this treatment will reduce pain in the patellofemoral joint. All we can take from it is that if a patient has three out of the five predictors, the treatment success rate will approach 94%. That’s pretty good if you ask me! The predictors were as follows:
- A difference in hip internal rotation from side to side of greater than 14°
- With the knee flexed, an ankle dorsiflexion range of more than 16°
- Positive navicular drop of greater than 3mm
- No stiffness after sitting for greater than 20 minutes
- The most painful activity is squatting
Of these factors, the difference in hip internal rotation was the strongest predictor. So, what does all this mean? I can tell you what it means for me as a chiropractor. If a patient with patellofemoral pain syndrome comes into the clinic, we can look at some of these factors. If there is a difference in hip internal rotation greater than 14° and three out of the five predictors are present, we will examine the lumbopelvic biomechanics to see if a chiropractic adjustment is appropriate. If the patient is comfortable with it as a treatment approach, then maybe we can add it to the rehabilitation plan for their knee pain.
Do you have patellofemoral pain? Knee pain?
Feel free to give us a call at Burlington Sports Therapy, we can help!
By: Dr. Kevin McIntyre
Iverson CA, Sutlive TG, Crowell MS et al. Lumbopelvic manipulation for the treatment of patients with patellofemoral pain syndrome: development of a clinical prediction rule. Journal of Orthopaedic & Sports Physical Therapy 2008; 38(6): 297-312.
Suter E, McMorland G, Herzog W, Bray R. Conservative lower back treatment reduces inhibition in knee-extensor muscles: a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics 2000; 23: 76-80.
Suter E, McMorland G, Herzog W, Bray R. Decrease in quadriceps inhibition after sacroiliac joint manipulation in patients with anterior knee pain. Journal of Manipulative and Physiological Therapeutics 1999; 22: 149-153.
Hillerman B, Gomes AN, Korporaal C, Jackson D. A pilot study comparing the effects of spinal manipulative therapy with those of extra-spinal manipulative therapy on quadriceps muscle strength. Journal of Manipulative and Physiological Therapeutics 2006; 29: 145-149.