Patellar or femoro-patellar syndrome and osteopathy
Introduction to patellar syndrome
Patellar syndrome, also known as patellofemoral pain syndrome (PFPS), is the leading cause of pain in the anterior aspect of the knee in adolescents and adults.
Its causes are still poorly identified and the diagnosis is made by questioning, clinical examination and possibly imaging. The main treatment is rehabilitation.
What is patellar syndrome?
Patellar syndrome is pain in the front of the knee at the level of the patella (or kneecap) and represents about 20% of consultations for gonalgia (knee pain).
This pathology affects more women and more particularly sportswomen, especially those who practice running, but can also affect sedentary people.
This syndrome is the result of poor mobility of the patella during knee movements. Indeed, this will generate a friction of the patella and a too important compression on the facets of this small bone. Patellofemoral syndrome is different from patellar instability and patellofemoral osteoarthritis, even if patellar instability favors the development of this syndrome for the reasons previously explained.
Anatomical reminders:
Thepatellofemoral joint is the joint between the femur and the patella.
The quadriceps muscle ends in a common tendon called the quadricipital tendon which ends on the upper part of the patella. It then extends into the patellar tendon which ends on the anterior tibial tuberosity (ATT)
Biomechanics
The patella, located in front of the knee, has the role of protecting the knee from direct trauma.
The patella articulates with the femur like a pulley and allows the extensor apparatus to be guided. It therefore transmits the force of extension and slows down flexion.
Patella during knee flexion:
- It enters the trochlea of the femur from 30°,
- Between 30° and 60° the middle part of the patella is in contact with the femur,
- It is beyond 90° that the constraints are distributed on the internal and external facets of the patella
Too much repeated bending, jumping, and squatting can overstress the friction area, especially when the patella is no longer perfectly aligned.
The stresses on the patellofemoral joint vary according to the activities:
- Walking: x 0.5 times body weight
- Stair climbing : x 3,3
- Weight training / jumps / running: can go up to x 20 depending on the exercises
The symptoms of patellofemoral syndrome
Symptoms
- Pain in the anterior aspect of the knee, on or around the patella
- Sign of the cinema: pain on prolonged sitting
- Pain when going up or down stairs
- Pain when squatting or inability to squat
- Sensation of crackling when bending the knee
Clinical examination
The objective of the clinical tests is to evaluate the mobility of the patella in order to ensure good or bad patellofemoral congruence. The examination includes all orthopedic tests of the patella:
- Sign of the planer
- Patellar Apprehension Test
- Bayonet sign
- Smile sign
But also orthopedic tests of the knee to eliminate another cause.
Causes of patellar syndrome
- Patella misalignment (genu valgum, etc)
- Flat feet or feet with a collapse of the internal arch
- Lack of muscle in the hamstrings and quadriceps
- Lower limb deformity
- Trauma
Treatment of patellofemoral syndrome
Advice
- Running with adapted shoes
- Avoid running on tarmac
- Avoid efforts that are too intense or too long in one go, favour progressive activity
- To have well-muscled legs(sheathing, muscle strengthening, etc.)
Rest
Rest is necessary especially when the pain is very important, it is necessary to avoid the repetition of flexion extension of the knee. However, it is important to work the knee a little after a few days of rest. Complete immobilization for a long time is not the solution.
Ice cream?
For many years, cold has been found to provide short-term relief. On the other hand, cold limits inflammation, which is the body's natural healing process. So unless the pain is too great, icing is no longer recommended.
Installation of kinesiotaping bands
The application of a kinesiotaping bandage allows the patient to be relieved by promoting the drainage of the inflammation but also by allowing the correction of the patella's position. During treatment and when resuming physical activity, the application of K-tape is very suitable.
Stretching and muscle strengthening
A work of strengthening and stretching of the hamstring and quadriceps muscles and a good balance between these two exercises is essential.
A physiotherapist can accompany you in this process but it will be necessary that after the sessions, regular exercises are done at home.
Podiatric assessment and possible orthopedic inserts
In cases of patellar syndrome, a podiatric assessment is strongly recommended in order to investigate the architecture of the lower limbs and more particularly the feet and knees.
In case of imbalance, such as a foot that tends to collapse inward, the podiatrist can make a custom-made insole to limit this imbalance.
Attention, patellofemoral syndrome does not necessarily mean soles!
Osteopathy and patellar syndrome
After the interrogation that will orient him towards the diagnosis, the osteopath will first of all start with an observation of the posture in order to understand the cause of the pain. Then with specific tests, he will test the knee to determine the structure in pain (bone, ligament, meniscus, etc.) then he will continue his tests to affirm the cause of the problem and the blockages caused by this problem.
With a set of techniques, he will work painlessly and manipulate the patient to allow his body to function optimally. If your osteopath is trained(see the training of your osteopath), he will be able to apply kinesio taping and give you specific advice for your rehabilitation, he will also be able to redirect you to a specialist (physiotherapist, podiatrist, orthopedist) if necessary.
Marie Messager
Osteopath for sports
in Versailles Chantiers
78000 - Yvelines
