Patello-femoral (PF) joint pain is the most common cause of knee pain that we help people with in the clinic. The PF joint refers to your kneecap (the patella) gliding up and down a shallow groove in your thigh bone (the femur).
This joint is pretty easy to locate: just sit with your knee out straight, with your muscles relaxed. You should be able to grip the sides of your kneecap and wiggle it from side to side. Now, if you try to tighten your quad muscles on the front of your thigh (think of pushing your knee fully straight), you should be able to feel this snug up your kneecap so that you can no longer push it side to side.
This should give you an idea of how shallow the joint is, which leads us to the problem with the PF joint and why pain is so common: since the joint is so shallow, it relies almost exclusively on muscular control to stay in good alignment.
As you bend and straighten your knee, your kneecap should stay in good alignment with the groove. When the alignment changes, especially over a long period of time, you start to develop pain and irritation underneath the kneecap. This pain is amplified by more demanding activities, such as squatting down, going up and down stairs (especially down) and trying to stand up from a low chair.
Now that you know what PF pain looks like, let’s talk about what causes it.
As I mentioned above, keeping this joint happy depends largely on good muscular control of the kneecap as it tracks up and down in its groove. If you recall that the quadriceps muscle group engulfs the kneecap, it makes sense that adequate quad strength is vital to the success of this joint.
Weakness in the quads, especially the inner portion called the “VMO”, is the most common cause for PF joint pain. This leads to one of the most important treatment concepts for this pain: strengthening the quad muscles, with an emphasis on the VMO.
Sounds really simple, right? To some extent, it is simple. But not quite… Just treating PF joint pain with quad strengthening will usually give you a good amount of pain relief.
But since the knee is right in the middle of your leg, you have to keep in mind that the alignment of the knee is directly affected by the joints above and below. If you ignore the alignment of the hip and the ankle, quad strengthening might not be enough. Throw in weakness of certain hip muscles, some tightness in your IT band, and a fair amount of pain, and all of a sudden just strengthening the quads is no longer your best solution.
But don’t let that get you down! I’m going to share a lot of helpful information with you about PF joint pain and knee pain in general that will allow you to start reducing your pain right away.
Here are a few helpful tips to get the ball rolling:
- Tip #1: strengthen your quads and hips (more details next week)
- Tip #2: check your ankles (if you have low arches, consider supporting them with inserts)
- Tip #3: avoid painful activities, such as squatting down too deep(this is temporary)
In the video below, I’ll demonstrate the top 5 exercises to perform to start improving your quad and hip strength, which will allow you to start eliminating your pain.
Here’s the video!