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PATELLO FEMORAL PAIN SYNDROME (PFPS)Knee Cap pain.Patello Femoral Pain Syndrome is pain around the knee cap due to bruising or degeneration of the cartilage under the kneecap. More specifically, between the patella and the femur, hence the name. The Quadriceps is a group of four extremely powerful upper thigh muscles. Their function is to flex the hip (raise the femur), and extend the knee - straighten the lower leg. (There are far more muscles in the thigh, but four feed into the Patella).
For example, when raising yourself up from a sitting to a standing position, the Quadriceps is the primary muscle in the leg that is used. Obviously in walking, running and jumping the Quad, as we call it, is a prime mover. The forces transmitted to the lower leg via an ingenious system of tendons are enormous so, to protect the Quad tendon from fraying as it passes over the Femur bone, a very special small bone called the Patella (knee cap) is provided to transmit the forces smoothly to the lower leg. In the following pic, can you see the two tendons (Quadriceps and Patella tendons) and the Patella?
Then take home a delic Eisbein, bake it so the fat is lovely and crackly crisp, and enjoy it with mashed potatoes, peas and, if you have the privilege of knowing someone who can brew (yes, it's brewed like beer) some sauerkraut. Make sure you take it with a decent Greek salad or you will find your cholesterol going into orbit. An aside: Want to know why a glass of red wine helps keep your cholesterol down?
Sorry vegetarians, in poor taste, I guess. Seriously though, this cartilage is really prone to wear and tear. Beware you obese ladies, it's this patella cartilage that's going to get you. The knee was overdesigned for stress, but not for 90 kg+. Nature never figured that humans could get that heavy. Serious pain from PATELLO FEMORAL PAIN SYNDROME is being scribbled onto the menu for you. Sexism? Nope, because of the so called Q-angle in the hip, women are far more prone to hip and knee problems. There are other reasons too. Sometimes because of malformation, the patella rides high (or low), and even subluxates and dislocates. A good crack on the patella with a hockeystick, a hard fall, full on the kneecap, or simply having to negotiate the Thirty-nine Steps ten times every day.
DiagnosisIt doesn't take rocket science to diagnose PFPS. The presentation is usually fairly clear. Pain whilst kneeling on the kneecap, pain getting up from kneeling or squatting or getting out of a deep chair, pain on the stairs. Usually walking on level ground is less of a problem.The diagnosis is confirmed by a standard orthopaedic test: Clarke's test. Read more … What's to be done?PATELLO FEMORAL PAIN SYNDROME is one of those conditions that nobody mentioned in my training. It probably hadn't yet been named. Simply forced to figure things out, it soon became evident that PFPS responds like all other joints problems to the basics of chiropractic care.Mobilise the joint, use some ice if there is swelling and inflammation, give some quad exercises called Quad setting, and heypresto, this condition that medicine seems to think is untreatable ("I'm afraid you have arthritis, Mrs Jones, you will just have to learn to live with it, there's nothing to be done.") actually responds astonishingly well to Chiropractic. One protocol that I use, is to grind the patella quite hard onto the femur - to tolerance of pain - and astonishingly the really rough crystals can be ground down. There will be some pain for a few days, some swelling but nothing that ice can't handle, and hey presto, it gets better. Not cured, mind you, but better. And, if your weight is the problem, and you don't do something, expect an early retreat to the rolator and loss of independence.
ArthroscopyArthroscopy is the most common knee surgery done today. For some mind-blowing research done by the top US orthopaedic surgeon, click here.Knee pain in the child?The hip has a penchant for referring pain to the knee. In every case of knee pain, the hip should also be examined, but never is this more true than in the limping child complaining of vague pain in knee - thigh - groin.Never will I forget the lecture given by a leading orthopaedic surgeon who told a group of chiropractors how often he had to cover for colleagues who had operated on a knee, having missed the fact that the knee pain was simply being referred from the hip. An aside. Do chiropractors miss things? Yes! I do, so I presume my colleagues do too. Is your excellent chiropractor just getting too busy? You have the feeling you are on a treadmill. In and out? Short on listening to you? Short on examination? It's a problem we all have, and I have to speak to myself very firmly occasionally! Perhaps it's time to consider a move to a younger graduate who will indeed be short on experience, but have more time for you. MONTHLY NEWSLETTERSigned up yet for our monthly news letter? Full of tidbits about better health, not just about conditions like PATELLO FEMORAL PAIN SYNDROME, but ways to eat healthier, exercise ... In the November 2008 edition we will cover a section on what the elderly can do to stop themselves falling. Balance training.
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