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Patellofemoral Injuries: A Physiotherapist’s Perspective and Personal Journey

Patellofemoral Injuries: A Physiotherapist’s Perspective and Personal Journey

by Andrew Xotta Dickson

Patellofemoral injuries, affecting the joint between the kneecap (patella) and the thigh bone (femur), can be a source of significant pain and discomfort. It is a common musculoskeletal issue many of us encounter over our lifetime.

As a physiotherapist, it’s important to understand the challenges faced with these injuries to develop an effective rehabilitation plan as they can really affect the quality of someone’s life. Unfortunately, I know all too well…

My personal experience with this injury began 18 months ago, after returning to soccer very deconditioned and missing most of preseason due to illness. I had a stint of the flu just before the Christmas break which was closely followed up by catching Covid-19 just after the new year (would not recommend!). It all came at a time when I should have been gradually increasing my activity to prepare myself for the upcoming season. And as we all know, preparation is key to prevention. However, instead I was decreasing activity, resting to recover from being sick. This resulted in me returning to playing despite missing several months of conditioning and that’s when I first started to have pain in my knee – lesson learnt!

We’ll explore the implications of this later, but for now we’ll discuss the anatomy of the patellofemoral joint, common causes of these injuries, symptoms, and how physiotherapy plays a pivotal role in managing and preventing these issues.

Anatomy of the Patellofemoral Joint:

The patellofemoral joint is a crucial component of the knee allowing for smooth movement during activities like walking, running, and jumping. The kneecap is embedded within the quadriceps tendon and moves along the femoral groove when bending and straightening the knee. The function of this joint is influenced by various factors, including muscle strength, biomechanics, and overall joint health. When this delicate balance between these elements are disrupted, it can lead to patellofemoral dysfunction.

Common Causes of Patellofemoral Injuries:

1. Muscle Imbalances – Muscular imbalances, especially weakness or tightness in the quadriceps, hamstrings, and hip muscles, can alter the patellar tracking, leading to increased pressure on the joint. Addressing these imbalances is a crucial aspect of effective rehabilitation.

2. Overuse and Repetitive Stress – Activities that involve repetitive knee movements, such as running, cycling, jumping or squatting, can contribute to overuse injuries. Prolonged stress on the patellofemoral joint without adequate rest can lead to inflammation and pain. Athletes involved in sports that involve these activities, like basketball, soccer, or track and field, may be particularly susceptible.

3. Biomechanical Factors – Structural abnormalities, such as a misaligned patella or issues with the femoral groove, can increase the risk of patellofemoral injuries. Poor biomechanics, such as improper foot arch support, may alter the joint’s mechanics, causing abnormal loading and wear on the joint surfaces.

4. Trauma – Direct trauma or injury to the knee, such as a fall or impact, can damage the structures within the patellofemoral joint. Understanding the specifics of the injury is essential for tailoring an appropriate rehabilitation plan.

Symptoms of Patellofemoral Injuries:

1. Anterior Knee Pain – Pain at the front of the knee, exacerbated by activities like climbing stairs, sitting for prolonged periods, or engaging in physical exercise, is a hallmark of patellofemoral dysfunction.

2. Swelling – Inflammation and swelling around the knee joint may occur, further contributing to discomfort and limiting range of motion.

3. Crepitus – Patients may report a grinding or popping sensation within the knee joint, known as crepitus, indicating irregularities in the joint surfaces and tracking of the patella through its femoral groove.

4. Weakness and Instability – Some individuals may experience feelings of instability/weakness or a sense that the knee is giving way, particularly during weight-bearing activities.

How can physiotherapy help?

– Muscle Strengthening: Physiotherapists focus on strengthening the quadriceps, hamstrings, and hip muscles to restore balance and stability around the knee. Choosing particular exercises is important in this phase as to not further aggravate the injury.

– Biomechanical Assessment: Identifying and addressing faulty movement patterns or biomechanical issues is crucial. Gait analysis and specific exercises can correct alignment and improve joint function.

– Flexibility and Mobility Exercises: Stretching exercises target tight muscles, improving flexibility and reducing stress on the patellofemoral joint.

– Activity Modification: Modifying or temporarily avoiding activities that exacerbate symptoms allows the joint to heal. Physiotherapists guide patients in gradually returning to regular activities.

– Bracing and Taping: Depending on the severity of the injury, bracing or taping techniques may be employed to provide additional support and enhance joint stability.

My personal experience!

Now that we have a good understanding around patellofemoral injuries, we are going to circle back to my personal experience.

Shortly after returning to soccer and jumping straight into full training and game scenarios post an extended period off due to illness, I developed the anterior knee pain, swelling, stiffness, crepitus in and around my knee cap as mentioned above. This significantly started to impact my soccer so I followed my own recommendations, and sought the help of a physiotherapist to assist in assessing my movement habits, strength levels, range of movement to help guide my rehabilitation. Lucky I am in the right place!

After modifying activity first and then rebuilding my strength, I was able to return to the field to continue playing the remainder of the season.

At this point, you are probably thinking the journey’s over. Of course! I’m a physio, and I should know what I’m doing with my rehab to get me back to 100% ASAP. Well, in theory yes. But it wasn’t perfect, and albeit returning to sport and managing, I still had persisting symptoms.

As we remind our clients, progress is not linear.

This is when I decided to have an MRI and seek the advice of an orthopaedic surgeon. The imaging showed I had developed a lesion in the cartilage behind my knee cap which was disrupting the smooth tracking of the kneecap through its groove and irritating my knee when doing high intensity exercises; mainly involving knee bending. Despite the fact that physiotherapy improved my symptoms significantly which enabled me to return to soccer, there were still some high demanding activities that were problematic for my knee.

Due to the reduced ability of the cartilage behind my kneecap to heal, I opted for surgical intervention so I could return to playing the sport I loved (and still love) to play.

Whether surgery is required for this injury is often dependent on what your injury is stopping you from doing and what your goals are. For me, it was important that I return to my sport – if your goals are different, your management of your injury might look very different, so it’s always important to work with a physiotherapist throughout your recovery.

My surgery consisted of a knee arthroscopy to perform a microfracture procedure of the cartilage behind my knee cap and implanting a gel to better protect the healing surface. This allows for a blood supply to reach the surface area of the cartilage that is affected to encourage a new cartilage to form over my “pothole”. A relatively short post-op recovery, rehabilitation followed to the T, and we’re well on our way to a ‘good’ knee.

From my personal experience as a physiotherapist and soccer player, I can fully appreciate how patellofemoral injuries can significantly impact an individual’s quality of life and hinder their ability to engage in their sporting activities. If you are currently suffering with this injury or one similar, I empathise – and I would love to help you through your recovery journey!

It’s vital with these injuries to seek professional help to assist in the comprehensive management of these injuries, addressing the underlying causes, promoting healing, and having guidance towards a pain-free and functional lifestyle. Early intervention and a tailored rehabilitation program are key elements in ensuring optimal outcomes for individuals with patellofemoral injuries.

If you have a sports injury and are looking for support, please book a physiotherapy appointment with myself or one of my fantastically experienced colleagues!

Book online via the button in the top right hand corner, or give us a call on 8352 3582. We can’t wait to see you in the clinic soon!

 

Thanks for reading!

 

 

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