WHAT IT IS AND HOW TO DEAL WITH IT EFFECTIVELY?
“Historically, clinicians have used a myriad of interventions, many of which have little, if any, supporting evidence.“ Drs. Lori Bolga and Michelle Boling from 2011’s An Update for the Conservative Management of Patellofemoral Pain Syndrome: A Systematic Review of the Literature from 2000 to 2010
Depending on whose research you believe, the number one or number two reason that people visit “Sports Physicians” is Palellofemoral Syndrome (aka Patellar Tracking Syndrome, Chontromalacia Patella, and several others). The quote at the top of the page was written over 15 years ago, and comes from a paper that is still widely considered to be the definitive word on the topic. The pain itself is found most commonly in the front of the knee and is thought to arise from contact between the underside of the patella (knee-cap) and the thigh bone (femur). It occurs most often in younger female athletes, although it is commonly found in runners of all ages (male as well), basketball players, as well as athletes from various other sports.
Although there are a wide array of treatment options for this problem, the “gold standard” involves various exercises to strengthen the quadriceps (front thigh muscles). My goal today is to show you why this is not necessarily always the best or only option — particularly if you are one of those who may have been told that a Lateral Release Surgery is your only option.
As you might imagine, most sources will tell you that Patellofemoral Syndrome is caused by weak quadriceps (front thigh muscles). I am personally not convinced that this is always the case. In fact, I would say that this assessment is often times blatantly incorrect.
I see a lot of people with Patellar Tracking Syndrome and more often than not, find the opposite to be true (weak hamstrings being overpowered by the quads, which are — or at least should be — the strongest muscle group in the body). This is particularly true in athletes. In most athletes (particularly those who are well-trained or weight lifters) the quadriceps are significantly stronger than the hamstrings. Not only that, but when people train their legs in the weight room, most of the common exercises for legs (squats, hack squats, presses on the leg sled, leg extensions) mostly or entirely work the quadriceps. In fact, other than maybe doing some hamstrings curls, I find that many athletes are doing very little for their hamstrings.
Below is a video of Jennifer that was shot three days ago. Although I had treated Jennifer for Patellofemoral Syndrome over a decade ago, it only took one treatment to solve a (severe) knee problem that she had dealt with for five years. I do not actually remember doing this treatment, but when I recently suggested that she might have Fasical Adhesions in her neck, she reminded me of the Fascial Adhesions that she had in her knee. I told her that I would be doing an article on that particular problem on Monday, so she agreed to do a video for us (thanks Jennifer!).
Symptoms of Patellofemoral Syndrome include pain in and around the knee. This is because, according to a 2009 article by Tom Plamodon, “The cause of pain and dysfunction often results from abnormal forces (e.g. increased pull of the lateral quadricep retinaculum with acute or chronic lateral PF subluxation / dislocation)“. In light of the fact that this is the medical community’s current thought process on this matter, this is an important statement to understand. And in order to grasp it, you’ll first have to understand what a RETINACULUM is. A Retinaculum (often referred to as an APNONEUROSIS) is simply a very wide, flattened or thin, fascia-like tendon. Listen to Wikipedia’s definition of a common treatment for Patellar Tracking Syndrome; the Lateral Release.
“A Lateral Release Surgery (also called a “Lateral Retinacular Release”) is a surgical procedure to release tight capsular structures (lateral retinaculum) on the outer aspect (lateral aspect) of the kneecap (patella). This is usually performed because of knee pain related to the kneecap being pulled over to the outer (lateral) side and not being able to run properly in the center of the groove of the femur bone as the knee bends and straightens.”
Although strengthening of the quadriceps usually solves this particular pain, it can actually worsen the imbalance between the quadriceps and the hamstrings. It was not that long ago that I read an article talking about the incredible increase in the numbers of cases of non-contact knee ruptures seen in today’s athletes — particularly female athletes. The authors touted the fact that the number one cause of non-tramatic ACL ruptures in the female population, the quads were overpowering the hamstrings.
For more information about PATELLO-FEMORAL SYNDROME and how to avoid a “Lateral Release” surgery, just take a few minutes to click and read the link. You may want to look at our COLD LASER PAGE as well.