Materiały źródłowe

• #1 Patellofemoral Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557657/

  Patellofemoral syndrome (PFS) is one of the most common causes of anterior knee pain. […] The etiology of patellofemoral syndrome is without a clear consensus; however, it is likely multifactorial and secondary to training practices. It is thought to involve 6 anatomic areas, including subchondral bone, synovium, retinaculum, skin, nerve, and muscle. […] Studies point to four major contributing factors: malalignment of the lower extremity and/or patella, muscular imbalance of the lower extremity, overactivity/overload, and trauma. […] Of the four contributing factors, overuse appears to be the most important. […] Many patients with PFS do not demonstrate any signs of malalignment. Instead, during careful interviewing, overload of the patellofemoral joint is often described, which can lead to the development of PFS. […] Direct or indirect injuries to the patellar area can damage structures leading to PFS. […] Though studies have pointed to the above causes or risks of developing patellofemoral syndrome, most will agree its development is rarely secondary to a single component.

• #1 Patellofemoral pain syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/symptoms-causes/syc-20350792

  Patellofemoral pain syndrome can have several causes. It’s been linked with: […] Overuse. Running or jumping sports put repeated stress on the knee joint, which can cause irritation under the kneecap. […] Muscle imbalances or weaknesses. Patellofemoral pain can occur when the muscles around the hip and knee don’t keep the kneecap in line. Moving the knee inward during a squat has been linked to patellofemoral pain. […] Injury. Trauma to the kneecap, such as when the kneecap gets out of place or breaks, has been linked to patellofemoral pain syndrome. […] Surgery. Knee surgery can increase the risk of patellofemoral pain. This is especially true of repair to the anterior cruciate ligament using one’s own patellar tendon as a graft.

• #2 Patellofemoral Pain Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0115/p88.html

  Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults younger than 60 years. The cardinal feature of PFPS is pain in or around the anterior knee that intensifies when the knee is flexed during weight-bearing activities. […] Patellofemoral pain syndrome (PFPS) is a common cause of knee pain in adolescents and adults younger than 60 years. […] Established risk factors for PFPS include female sex and activities such as running, squatting, and going up and down stairs. […] Dynamic valgus is another mechanism associated with PFPS. Dynamic valgus is a body position in which the knee collapses medially from excessive valgus, internal-external rotation, or both. […] Patellar maltracking is believed to play a role in PFPS. Patellar maltracking, or lateral translation, increases with load-bearing positions, such as squatting, in patients with PFPS.

• #2 Patellofemoral Pain Syndrome – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/

  Patellofemoral pain syndrome (PFPS) is a broad term used to describe pain in the front of the knee and around the patella, or kneecap. It is sometimes called „runner’s knee” or „jumper’s knee” because it is common in people who participate in sports especially females and young adults but PFPS can occur in nonathletes, as well. […] Many things may contribute to the development of PFPS. Problems with the alignment of the kneecap and overuse from vigorous athletics or training are often significant factors. […] In many cases, PFPS is caused by vigorous physical activities that put repeated stress on the knee such as jogging, squatting, and climbing stairs. It can also be caused by a sudden change in physical activity, which can be related to the frequency of activity (e.g., increasing the number of days you exercise each week) or to the duration or intensity of activity (e.g., running longer distances).

• #3 Patellofemoral Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557657/

  Patellofemoral syndrome (PFS) is one of the most common causes of anterior knee pain. […] The etiology of patellofemoral syndrome is without a clear consensus; however, it is likely multifactorial and secondary to training practices. It is thought to involve 6 anatomic areas, including subchondral bone, synovium, retinaculum, skin, nerve, and muscle. […] Studies point to four major contributing factors: malalignment of the lower extremity and/or patella, muscular imbalance of the lower extremity, overactivity/overload, and trauma. […] Of the four contributing factors, overuse appears to be the most important. […] Many patients with PFS do not demonstrate any signs of malalignment. Instead, during careful interviewing, overload of the patellofemoral joint is often described, which can lead to the development of PFS. […] Direct or indirect injuries to the patellar area can damage structures leading to PFS. […] Though studies have pointed to the above causes or risks of developing patellofemoral syndrome, most will agree its development is rarely secondary to a single component.

• #4 Patellofemoral Pain Syndrome (PFPS): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17914-patellofemoral-pain-syndrome-pfps

  Patellofemoral pain syndrome (PFPS) is knee pain under or around your patella (kneecap). Experts arent certain what causes it, but you can usually treat it with the RICE method, physical therapy and by slowly ramping up your activity level. […] Patellofemoral pain syndrome usually develops over time. […] Experts arent sure exactly what causes PFPS. Some factors or issues that may cause it include: Overusing your knees: Doing the same kind of motion often (like jumping a lot or working on your hands and knees) might cause PFPS. Weak or tight muscles around your knee: If the muscles in your legs around your knee (especially your quad muscles) are weak, they might not be able to support your knee as they should. Similarly, if your quads and other muscles arent flexible enough, they can put too much tension on your knee. Suddenly increasing your activity level: You might develop PFPS if you start a new sport or activity or increase how often youre active. PFPS might also happen if you increase the intensity of your practices or training. The natural shape of your knee: If your patella is naturally an unusual shape or doesnt fit into the groove in your femur as it should, you might develop PFPS without any extra stress or strain on your knees. […] PFPS usually gets worse over time if its not diagnosed and treated. On top of increasing pain, untreated PFPS may increase your risk of injuries.

• #5 Patellofemoral Pain Syndrome – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/

  Patellofemoral pain syndrome (PFPS) is a broad term used to describe pain in the front of the knee and around the patella, or kneecap. It is sometimes called „runner’s knee” or „jumper’s knee” because it is common in people who participate in sports especially females and young adults but PFPS can occur in nonathletes, as well. […] Many things may contribute to the development of PFPS. Problems with the alignment of the kneecap and overuse from vigorous athletics or training are often significant factors. […] In many cases, PFPS is caused by vigorous physical activities that put repeated stress on the knee such as jogging, squatting, and climbing stairs. It can also be caused by a sudden change in physical activity, which can be related to the frequency of activity (e.g., increasing the number of days you exercise each week) or to the duration or intensity of activity (e.g., running longer distances).

• #6

  https://link.springer.com/article/10.1007/s40141-014-0044-3

  Patellofemoral pain syndrome (PFPS) is one of the most prevalent musculoskeletal conditions seen in sports medicine clinics. The pathophysiology of PFPS is multifactorial. These factors include both extrinsic risk factors, such as changes in training frequency or intensity, training surfaces and inappropriate shoe wear, and intrinsic risk factors, including lower extremity malalignment and muscle and soft tissue imbalances. […] It is proposed that PFPS arises from a combination of biomechanical factors and tissue imbalances causing improper tracking of the patella in the trochlea of the femur, eventually leading to increased stress at the patellofemoral joint. […] Postulated risk factors include both intrinsic and extrinsic risk factors. Extrinsic risk factors include training errors associated with many overuse injuries in sports, such as recent changes in training surface or topography, sudden increase in frequency or intensity, and inappropriate shoe wear.

• #7 Patellofemoral Pain Syndrome Symptoms & Treatment | UPMC

  https://www.upmc.com/services/orthopaedics/conditions/patellofemoral-pain

  Patellofemoral pain syndrome occurs when your patella (kneecap) cartilage becomes overloaded due to overuse, often caused by high-impact activities, or as a result of poor alignment. […] You are more likely to develop patellofemoral pain syndrome if you play high-impact sports such as football, basketball, soccer, and tennis, or if you are a runner. […] These activities all have the potential to aggravate the patella cartilage. In addition, running on uneven surfaces, like hills or trails, or playing on multiple surfaces (such as hard and clay courts in tennis) also may increase the likelihood of patellofemoral pain.

• #8 Patellofemoral Pain Syndrome – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/

  Patellofemoral pain syndrome can also be caused by abnormal tracking of the kneecap in the trochlear groove. In this condition, the patella is pushed out to one side of the groove when the knee is bent. This abnormality may cause increased pressure between the back of the patella and the trochlea, irritating soft tissues. […] Factors that contribute to poor tracking of the kneecap include: Problems with the alignment of the legs between the hips and the ankles, which may result in a kneecap that shifts too far toward the outside or inside of the leg, or one that rides too high in the trochlear groove a condition called patella alta. […] Muscular imbalances or weaknesses, especially in the quadriceps muscles at the front of the thigh and the muscles that externally rotate and move the hip away from your body (this movement is called abduction). When the knee bends and straightens, the quadriceps muscles and tendon help to keep the kneecap centered within the trochlear groove, together with the hip muscles that help control the position of the thigh bone. Weak or imbalanced quadriceps and hip muscles can cause poor tracking of the kneecap within the groove.

• #9 Patellofemoral Pain Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0115/p88.html

  Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults younger than 60 years. The cardinal feature of PFPS is pain in or around the anterior knee that intensifies when the knee is flexed during weight-bearing activities. […] Patellofemoral pain syndrome (PFPS) is a common cause of knee pain in adolescents and adults younger than 60 years. […] Established risk factors for PFPS include female sex and activities such as running, squatting, and going up and down stairs. […] Dynamic valgus is another mechanism associated with PFPS. Dynamic valgus is a body position in which the knee collapses medially from excessive valgus, internal-external rotation, or both. […] Patellar maltracking is believed to play a role in PFPS. Patellar maltracking, or lateral translation, increases with load-bearing positions, such as squatting, in patients with PFPS.

• #10 Patellofemoral Pain Syndrome

  https://www.cham.org/HealthwiseArticle.aspx?id=tp22235spec

  Patellofemoral pain syndrome is pain in the front of the knee. It sometimes is caused by wearing down, roughening, or softening of the cartilage under the kneecap. […] Patellofemoral pain syndrome may be caused by overuse, injury, excess weight, a kneecap that is not properly aligned (patellar tracking disorder), or changes under the kneecap.

• #11 Patellofemoral pain syndrome (runner’s knee): Treatment and more

  https://www.medicalnewstoday.com/articles/319458

  Age: Adolescents and young adults are at the highest risk of patellofemoral syndrome, although it may also affect older adults. […] Sex: Women are more likely than men to develop this condition, possibly due to greater risk of muscle imbalance and the wider angle of the female pelvis. […] High-impact activities: Engaging in high-impact or weight-bearing activities, including running, jumping, or squatting causes repetitive stress to the joints, and increases the risk of knee injury. […] Flat feet: People with flat feet may be at higher risk of patellofemoral syndrome as they place additional stress on their knee joints.

• #12 Patellofemoral Pain Syndrome | Symptoms & Treatments | Avid Sports Medicine

  https://avidsportsmed.com/patellofemoral-pain-syndrome/

  Flat feet or high arches. Individuals with flat feet or high arches may experience changes in the alignment and function of the knee joint, leading to patellofemoral pain. […] A higher sitting kneecap (patella alta) is more prone to maltracking, increasing the likelihood of developing PFPS. […] Women typically have wider hips, leading to a greater angle (known as the Q-angle) between the thigh bone and the knee. This increased angle can contribute to a higher likelihood of kneecap misalignment and subsequent stress on the patellofemoral joint.

• #13 Patellofemoral Pain | Orthopedics & Sports Medicine

  https://health.uconn.edu/orthopedics-sports-medicine/conditions-and-treatments/where-does-it-hurt/knee/patellofemoral-pain/

  The primary cause of anterior knee pain is an unbalanced set of forces across the patellofemoral joint causing the knee bone to not be centered within the trochlear groove, which is a part of the thighbone. […] The abnormal forces that act on the knee bone to cause this problem can be as simple as a muscular weakness or an imbalance between the various portions of the thigh muscles, tight ligaments either on the outside or the inside, having flat feet, being knock-kneed, or having significant ligamentous laxity. […] A significant knock-kneed position of the knees can also lead to and cause anterior knee pain. […] Flatfoot deformity is another contributor to anterior knee pain symptoms.

• #14 Patellofemoral Pain Syndrome – Symptoms, Causes, Treatment & Exercise

  https://www.sportsinjuryclinic.net/anterior-knee-pain/patellofemoral-pain-syndrome

  Increased training loads can be from increased volume, for example, increasing the number of miles run or days trained. This increases the overall load from repetitive strain on the patellofemoral joint. An increasing intensity such as through bounding or jumping exercises can also increase the load on the joint. […] Increased internal rotation of the femur or thigh bone may contribute to the development of patellofemoral pain. […] Increased knee valgus is also known as genu valgum or an increased Q angle. […] Increased tibia rotation is where the tibia or shin bone rotates inwards too much. This can cause the femur to rotate inwards and the patella to track incorrectly. […] Overpronation of the foot is where the foot rolls in too much and flattens. This has a knock-on effect of causing the tibia to rotate.

• #15 Patellofemoral Pain Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0115/p88.html

  Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults younger than 60 years. The cardinal feature of PFPS is pain in or around the anterior knee that intensifies when the knee is flexed during weight-bearing activities. […] Patellofemoral pain syndrome (PFPS) is a common cause of knee pain in adolescents and adults younger than 60 years. […] Established risk factors for PFPS include female sex and activities such as running, squatting, and going up and down stairs. […] Dynamic valgus is another mechanism associated with PFPS. Dynamic valgus is a body position in which the knee collapses medially from excessive valgus, internal-external rotation, or both. […] Patellar maltracking is believed to play a role in PFPS. Patellar maltracking, or lateral translation, increases with load-bearing positions, such as squatting, in patients with PFPS.

• #16 What Is Patellofemoral Pain Syndrome?

  https://www.icliniq.com/articles/orthopedic-health/patellofemoral-pain-syndrome

  Patellofemoral pain syndrome, abbreviated as PFPS, is colloquially called runners knee or jumpers knee. The precise etiology behind patellofemoral pain syndrome is currently obscure; however, several conditions have been identified that may either trigger it or aggravate pre-existing pain, enlisted as follows; The repetitive and vigorous strain on the knee joint. Malaligned or dislocated patella. Anatomical variations. Muscle weaknesses around the knee joint. Improper training techniques during athletics or exercise. Footwear-related issues. Playing surfaces that are hard and cause regular impacts. […] A functional malalignment or dynamic valgus may be the underlying cause of patellar maltracking. Dynamic valgus can be caused by reduced hip abductor strength or a pes pronatus valgus. Quadriceps disbalance, hamstring tightness, or iliotibial tract tightness are all symptoms of functional malalignment of this disease.

• #17 Patellofemoral pain syndrome (runner’s knee): Treatment and more

  https://www.medicalnewstoday.com/articles/319458

  Age: Adolescents and young adults are at the highest risk of patellofemoral syndrome, although it may also affect older adults. […] Sex: Women are more likely than men to develop this condition, possibly due to greater risk of muscle imbalance and the wider angle of the female pelvis. […] High-impact activities: Engaging in high-impact or weight-bearing activities, including running, jumping, or squatting causes repetitive stress to the joints, and increases the risk of knee injury. […] Flat feet: People with flat feet may be at higher risk of patellofemoral syndrome as they place additional stress on their knee joints.

• #18 Patellofemoral pain syndrome | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/leg-and-foot-problems-and-conditions/patellofemoral-pain-syndrome/

  Patellofemoral pain syndrome is a condition that causes pain behind or around the kneecap. […] The causes can vary between individuals, but its often as a result of altered loading of the patella (kneecap). […] The main contributing factors can be: weakness in the buttocks and thighs, tightness in the hamstrings and calf, sudden changes in activities. […] Other factors could be: repeated kneeling or bending of the knee, sitting or driving for a prolonged period of time, being overweight.

• #19 Patellofemoral Pain Syndrome | Symptoms & Treatments | Avid Sports Medicine

  https://avidsportsmed.com/patellofemoral-pain-syndrome/

  Flat feet or high arches. Individuals with flat feet or high arches may experience changes in the alignment and function of the knee joint, leading to patellofemoral pain. […] A higher sitting kneecap (patella alta) is more prone to maltracking, increasing the likelihood of developing PFPS. […] Women typically have wider hips, leading to a greater angle (known as the Q-angle) between the thigh bone and the knee. This increased angle can contribute to a higher likelihood of kneecap misalignment and subsequent stress on the patellofemoral joint.

• #20 Patellofemoral Pain Syndrome | Complete Physio

  https://complete-physio.co.uk/patellofemoral-pain-syndrome/

  Muscle imbalances or weaknesses patellofemoral pain can occur when the muscles around your hip and knee do not keep your kneecap properly aligned or supported in the trochlea groove. […] Poor foot biomechanics excessive pronation (flat foot) can result in increased pressure through the patellofemoral joint. […] Bony abnormality if your kneecap is shaped differently, is situated particularly high on your knee (known as patella alta), or if there is a bony defect affecting your kneecap, this may cause patellofemoral pain. […] Lower leg alignment this can have an effect on patellofemoral alignment, whether due to muscle imbalances, or the specific shape of the bones (such as knock knees or bow legs). […] Injury trauma to the kneecap, such as a dislocation or fracture, has been linked to patellofemoral pain syndrome.

• #21

  https://link.springer.com/article/10.1007/s40141-014-0044-3

  Intrinsic risk factors include bony, patellar and lower extremity malalignment along with muscle and soft tissue imbalances. […] Given the high lateral condyle, normally the lateral patellar facet is longer and more sloped to match, with a normal ratio of 3:2 of lateral to medial facet. Bony abnormalities such as dysplasia of the medial or lateral portions of the trochlear groove along with asymmetry of patellar facets can lead to decreased patellar stability and increased risk of PFPS. […] Lower extremity malalignment can have a significant influence on patellofemoral biomechanics and increase the risk for PFPS. […] Muscle and soft tissue imbalances are important risk factors leading to PFPS, but also the most treatable by multimodal therapy. […] Recently, proximal hip stabilization, specifically strength and activation of the musculature, has been implicated in PFPS.

• #22 Patellofemoral pain syndrome: causes and solutions

  https://epitact.co.uk/knee/patellar-syndrome/patellofemoral-pain-syndrome-causes

  PFPS or patellofemoral pain syndrome causes intense pain in front of the knee. It corresponds to a conflict between the thigh bone (femur) and the kneecap (patella), which does not slide properly in the groove during knee flexion. This multifactorial and intergenerational disease is one of the main causes of anterior knee pain. […] The causes of patellofemoral pain syndrome can be related to anatomy, physiology and even psychology. […] Anatomical abnormalities are major causes of PFPS. […] Morphological abnormalities in the lower limbs: genu valgum, postural disorders of the arch of the foot, etc. […] Anatomical problems affecting the trochlea or the patella like malformation of the trochlea or high position of the patella. It results in poor guidance of the patella in the trochlea.

• #23 Patellofemoral pain syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/symptoms-causes/syc-20350792

  Patellofemoral pain syndrome can have several causes. It’s been linked with: […] Overuse. Running or jumping sports put repeated stress on the knee joint, which can cause irritation under the kneecap. […] Muscle imbalances or weaknesses. Patellofemoral pain can occur when the muscles around the hip and knee don’t keep the kneecap in line. Moving the knee inward during a squat has been linked to patellofemoral pain. […] Injury. Trauma to the kneecap, such as when the kneecap gets out of place or breaks, has been linked to patellofemoral pain syndrome. […] Surgery. Knee surgery can increase the risk of patellofemoral pain. This is especially true of repair to the anterior cruciate ligament using one’s own patellar tendon as a graft.

• #24 Patellofemoral pain syndrome: a review of current issues – PubMed

  https://pubmed.ncbi.nlm.nih.gov/10565551/

  There is no clear consensus in the literature concerning the terminology, aetiology and treatment for pain in the anterior part of the knee. […] Three major contributing factors of PFPS are discussed: (i) malalignment of the lower extremity and/or the patella; (ii) muscular imbalance of the lower extremity; and (iii) overactivity. […] Muscle tightness and muscular imbalance of the lower extremity muscles with decreased strength due to hypotrophy or inhibition have been suggested, but remain unclear as potential causes of PFPS. […] Decreased knee extensor strength is a common finding in patients with PFPS. […] It is clear that further studies are necessary in order to establish the significance of various strength deficits and muscular imbalances, and to clarify whether a specific disturbance in muscular activation is a cause or an effect (or both) of PFPS.

• #25 Patellofemoral pain syndrome: a review of current issues – PubMed

  https://pubmed.ncbi.nlm.nih.gov/10565551/

  There is no clear consensus in the literature concerning the terminology, aetiology and treatment for pain in the anterior part of the knee. […] Three major contributing factors of PFPS are discussed: (i) malalignment of the lower extremity and/or the patella; (ii) muscular imbalance of the lower extremity; and (iii) overactivity. […] Muscle tightness and muscular imbalance of the lower extremity muscles with decreased strength due to hypotrophy or inhibition have been suggested, but remain unclear as potential causes of PFPS. […] Decreased knee extensor strength is a common finding in patients with PFPS. […] It is clear that further studies are necessary in order to establish the significance of various strength deficits and muscular imbalances, and to clarify whether a specific disturbance in muscular activation is a cause or an effect (or both) of PFPS.

• #26 ETIOLOGY OF PATELLOFEMORAL PAIN SYNDROME: A PROXIMAL LINK TO A DISTAL PROBLEM

  https://uknowledge.uky.edu/gradschool_diss/457/

  Patellofemoral pain syndrome (PFPS) is one of the most common, but least understood, knee disorders. Fulkerson (1997) believes that pathology may result from an excessive valgus force being applied to the patella. […] Powers (2003) has theorized that other structures can influence knee function, and researchers have shown that PFPS subjects can exhibit hip weakness and demonstrate altered hip kinematics during functional activities. […] PFPS subjects demonstrated quadriceps dysfunction but even greater hip weakness that was correlated more with pain. Contemporary rehabilitation has focused on quadriceps strengthening; however, results from this study support the importance of the hip.

• #27 Kneecap Pain | Patellofemoral Pain. What are the causes?

  https://www.physioclinic.ie/conditions/kneecap-pain/

  Research by Witvrouw et al. (2000) found four potential predictors for patellofemoral pain: Delayed quadriceps response time, A decrease in explosive strength, A shortened quadriceps, A hypermobile patella. […] Other risk factors identified in the research include: Gender: females are at greater risk, Training load: increased training load is associated with increased risk of PFP, Navicular drop. The navicular is a large bone on the inside of the foot. A drop may indicate poor foot biomechanics, Tightness of the gastrocnemius (calf) muscle. […] Although most experts discuss the erosion of the cartilage behind the kneecap as the source of injury in patellofemoral pain, in scientific experiments the cartilage itself was shown to be pain-free. The outer surface of the bone (subchondral bone) is highly innervated and has been shown to be a source of pain along with the fluid lining the knee joint (called synovial fluid). There is also a fat pad below the kneecap known as the infrapatellar or Hoffer’s fat pad which is thought to be a strong source of knee pain.

• #28 Patellofemoral Pain Syndrome – Symptoms, Causes, Treatment & Exercise

  https://www.sportsinjuryclinic.net/anterior-knee-pain/patellofemoral-pain-syndrome

  Poor flexibility of any of the muscles surrounding the knee joint can be a contributing factor, in particular, tight muscles on the outside of the knee and hip such as the tensor fascia lata and iliotibial band. […] The soft tissue surrounding the patella such as the lateral retinaculum and iliotibial band could be too tight whilst the vastus medialis muscle on the inside of the knee could be too weak. […] Neuromuscular control of the vastus medialis is assessed to identify if the muscles are contracting at the right time. Just because there is plenty of muscle bulk does not mean the muscles are working properly.

• #29 Patellofemoral Pain Syndrome – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/

  Patellofemoral pain syndrome can also be caused by abnormal tracking of the kneecap in the trochlear groove. In this condition, the patella is pushed out to one side of the groove when the knee is bent. This abnormality may cause increased pressure between the back of the patella and the trochlea, irritating soft tissues. […] Factors that contribute to poor tracking of the kneecap include: Problems with the alignment of the legs between the hips and the ankles, which may result in a kneecap that shifts too far toward the outside or inside of the leg, or one that rides too high in the trochlear groove a condition called patella alta. […] Muscular imbalances or weaknesses, especially in the quadriceps muscles at the front of the thigh and the muscles that externally rotate and move the hip away from your body (this movement is called abduction). When the knee bends and straightens, the quadriceps muscles and tendon help to keep the kneecap centered within the trochlear groove, together with the hip muscles that help control the position of the thigh bone. Weak or imbalanced quadriceps and hip muscles can cause poor tracking of the kneecap within the groove.

• #30 Patellofemoral Pain Syndrome | Diagnosis & Treatment for Physios

  https://www.physiotutors.com/conditions/patellofemoral-pain-syndrome/

  Weak glutes on the other hand can alter the leg axis if the femur adopts a more internally rotated position with regards to the tibia again impairing smooth movement of the patella within the femoral trochlea. […] A systematic review of prospective predictors found no significant link in many of the proposed anthropometric variables. […] So while the biomechanical link may not be so clear, the above coupled with a drastic increase in load (intensity, frequency, duration) may eventually lead to symptoms.

• #31 Patellofemoral Pain Syndrome (Runner’s Knee) | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/patellofemoral-pain-syndrome-runners-knee/

  A tight IT band (a tendon that runs along the outside of your thigh from your hip to your shin bone) is another risk factor for patellofemoral pain since it also helps to control the movement of the patella in its groove. […] Finally, tight hamstrings are a frequent cause of patellofemoral pain, especially in growing bodies.

• #32 Patellofemoral Pain Syndrome – Symptoms, Causes, Treatment & Exercise

  https://www.sportsinjuryclinic.net/anterior-knee-pain/patellofemoral-pain-syndrome

  Poor flexibility of any of the muscles surrounding the knee joint can be a contributing factor, in particular, tight muscles on the outside of the knee and hip such as the tensor fascia lata and iliotibial band. […] The soft tissue surrounding the patella such as the lateral retinaculum and iliotibial band could be too tight whilst the vastus medialis muscle on the inside of the knee could be too weak. […] Neuromuscular control of the vastus medialis is assessed to identify if the muscles are contracting at the right time. Just because there is plenty of muscle bulk does not mean the muscles are working properly.

• #33 Patellofemoral pain syndrome | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/leg-and-foot-problems-and-conditions/patellofemoral-pain-syndrome/

  Patellofemoral pain syndrome is a condition that causes pain behind or around the kneecap. […] The causes can vary between individuals, but its often as a result of altered loading of the patella (kneecap). […] The main contributing factors can be: weakness in the buttocks and thighs, tightness in the hamstrings and calf, sudden changes in activities. […] Other factors could be: repeated kneeling or bending of the knee, sitting or driving for a prolonged period of time, being overweight.

• #34 Patellofemoral Pain Syndrome (Runner’s Knee) | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/patellofemoral-pain-syndrome-runners-knee/

  A tight IT band (a tendon that runs along the outside of your thigh from your hip to your shin bone) is another risk factor for patellofemoral pain since it also helps to control the movement of the patella in its groove. […] Finally, tight hamstrings are a frequent cause of patellofemoral pain, especially in growing bodies.

• #35 ETIOLOGY OF PATELLOFEMORAL PAIN SYNDROME: A PROXIMAL LINK TO A DISTAL PROBLEM

  https://uknowledge.uky.edu/gradschool_diss/457/

  Patellofemoral pain syndrome (PFPS) is one of the most common, but least understood, knee disorders. Fulkerson (1997) believes that pathology may result from an excessive valgus force being applied to the patella. […] Powers (2003) has theorized that other structures can influence knee function, and researchers have shown that PFPS subjects can exhibit hip weakness and demonstrate altered hip kinematics during functional activities. […] PFPS subjects demonstrated quadriceps dysfunction but even greater hip weakness that was correlated more with pain. Contemporary rehabilitation has focused on quadriceps strengthening; however, results from this study support the importance of the hip.

• #36

  https://link.springer.com/article/10.1007/s40141-014-0044-3

  Intrinsic risk factors include bony, patellar and lower extremity malalignment along with muscle and soft tissue imbalances. […] Given the high lateral condyle, normally the lateral patellar facet is longer and more sloped to match, with a normal ratio of 3:2 of lateral to medial facet. Bony abnormalities such as dysplasia of the medial or lateral portions of the trochlear groove along with asymmetry of patellar facets can lead to decreased patellar stability and increased risk of PFPS. […] Lower extremity malalignment can have a significant influence on patellofemoral biomechanics and increase the risk for PFPS. […] Muscle and soft tissue imbalances are important risk factors leading to PFPS, but also the most treatable by multimodal therapy. […] Recently, proximal hip stabilization, specifically strength and activation of the musculature, has been implicated in PFPS.

• #37 Patellofemoral pain syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/symptoms-causes/syc-20350792

  Patellofemoral pain syndrome can have several causes. It’s been linked with: […] Overuse. Running or jumping sports put repeated stress on the knee joint, which can cause irritation under the kneecap. […] Muscle imbalances or weaknesses. Patellofemoral pain can occur when the muscles around the hip and knee don’t keep the kneecap in line. Moving the knee inward during a squat has been linked to patellofemoral pain. […] Injury. Trauma to the kneecap, such as when the kneecap gets out of place or breaks, has been linked to patellofemoral pain syndrome. […] Surgery. Knee surgery can increase the risk of patellofemoral pain. This is especially true of repair to the anterior cruciate ligament using one’s own patellar tendon as a graft.

• #38 Patellofemoral Pain Syndrome | Children’s Mercy Kansas City

  https://www.childrensmercy.org/departments-and-clinics/orthopedics/sports-medicine/injury-management/patellofemoral-pain-syndrome/

  Patellofemoral pain syndrome can also result from direct trauma such as falling onto the kneecap or hitting the knee. […] For most growing athletes with patellofemoral pain syndrome, there are a collection of factors that cause the pain. […] Anything that increases the strain on the soft tissue supporting structures around the kneecap can lead to a problem with how the kneecap moves through its groove in the thigh bone as you bend and straighten the knee. […] Weak hip and thigh muscles are an important cause of patellofemoral pain. […] A tight IT band (a tendon that runs along the outside of your thigh from your hip to your shin bone) is another risk factor for patellofemoral pain since it also helps to control the movement of the kneecap in its groove. […] Finally, tight hamstrings are a frequent cause of patellofemoral pain, especially in growing bodies. […] Growing athletes who are flat-footed, knock-kneed, or pigeon-toed tend to have higher rates of patellofemoral pain syndrome.

• #39 Patellofemoral pain syndrome: causes and solutions

  https://epitact.co.uk/knee/patellar-syndrome/patellofemoral-pain-syndrome-causes

  Patellar instability is another cause of patellofemoral pain syndrome: the kneecap tends to subluxate toward the external side of the knee. This can go until its complete luxation. […] Femoral and/or tibial torsion, which means the femur and/or the tibia present excessive twist inward or outward. […] Hypermobility of the patella, or excessive laxity of the knee joint, encourages luxation of the patella and causes PFPS. […] Chondromalacia is the lesion of a part of the knee joint cartilage. It appears for example when one frequently practises skiing or hiking. […] Muscle weakness or stiffness, especially of the quadriceps and hamstrings can also contribute to causing patellofemoral pain syndrome. […] Women are more prone to PFPS than men for biomechanical and anatomical reasons. Indeed, women usually have less muscle strength in the legs.

• #40 Patellofemoral Pain Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0115/p88.html

  Other etiologies of patellar instability, such as knee sprains, may also contribute to PFPS. […] A retrospective review of an orthopedic database including more than 30 million patients in the United States between 2007 and 2011 estimated the incidence of PFPS to be 1.75 million patients, or about 6%. […] In a prospective study of 1,319 healthy, physically active young adults without a previous PFPS diagnosis, 3% developed PFPS during 2.5 years of follow-up, and women were more likely to develop the condition than men.

• #41 Patellofemoral pain syndrome (runner’s knee): Treatment and more

  https://www.medicalnewstoday.com/articles/319458

  Patellofemoral syndrome can be caused by overuse of the knee joint, physical trauma, or misalignment of the kneecap. […] Patellofemoral syndrome happens when the back of the kneecap comes into contact with the thigh bone. The exact reason this occurs is not entirely understood, but it is linked to: […] Overuse of the knee: Activities that involve running or jumping put a repetitive strain on the knee joint, which can lead to pain in the patella. […] Muscle imbalance: When certain muscles, such as those around the hip and knee, are weak, they fail to keep adjacent body parts, including the kneecap, properly aligned. This may eventually lead to injury. […] Trauma: Injury to the kneecap, or knee surgery, may increase the risk of experiencing patellofemoral pain syndrome. […] Common risk factors for patellofemoral syndrome include:

• #42 Patellofemoral pain syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Patellofemoral_pain_syndrome

  Patellofemoral pain syndrome (PFPS) is knee pain as a result of problems between the kneecap and the femur. […] While the exact cause is unclear, it is believed to be due to overuse. Risk factors include trauma, increased training, and a weak quadriceps muscle. […] In most people with patellofemoral pain syndrome an examination of their history will highlight a precipitating event that caused the injury. Changes in activity patterns such as excessive increases in running mileage, repetitions such as running up steps and the addition of strength exercises that affect the patellofemoral joint are commonly associated with symptom onset. […] The cause of pain and dysfunction often results from either abnormal forces (e.g. increased pull of the lateral quadriceps retinaculum with acute or chronic lateral patellofemoral subluxation/dislocation) or prolonged repetitive compressive or shearing forces (running or jumping) on the patellofemoral joint. […] The medical cause of PFPS is thought to be increased pressure or on the patellofemoral joint. […] Patellofemoral pain syndrome can also result from fractures/trauma, internal knee derangement, osteoarthritis of the knee, and bony tumors in or around the knee.

• #43 Patellofemoral Pain Syndrome – Symptoms, Causes, Treatment & Exercise

  https://www.sportsinjuryclinic.net/anterior-knee-pain/patellofemoral-pain-syndrome

  Patellofemoral Pain Syndrome (PFPS) results from the patella (kneecap) rubbing on the femur bone underneath. […] The initial cause of patellofemoral pain syndrome is likely to be overused. This may be from external factors, for example, a sudden increase in training. Or it is from internal factors such as poor patella tracking. Identifying the cause is an important part of treatment. […] It can have a number of causes but damage to the cartilage itself cannot directly cause pain. This is because there are no blood vessels or nerves involved. However, it can lead to other problems which in turn result in pain. These include: Synovitis or inflammation of the synovial membrane surrounding the joint. Erosion of the cartilage and eventually the bone. Soft tissue injury, for example to the lateral retinaculum or patella fat pad.

• #44 Patellofemoral Pain Syndrome: Causes, Symptoms, and Treatment | Sage Sports Institute

  https://sagesportinstitute.com/patellofemoral-pain-syndrome-causes-symptoms-and-treatment/

  Misalignment of the knee joint or abnormal movement patterns such as overpronation of the feet or excessive inward movement of the knee (knee valgus) can contribute to PFPS. […] Injuries such as sprains, strains, or previous knee trauma can lead to altered mechanics, increasing the risk of developing PFPS. […] Wearing inappropriate shoes for physical activities, especially those with poor arch support, can contribute to knee pain and exacerbate PFPS. […] PFPS is most common in adolescents and young adults, particularly those who are active in sports or physical activity. However, it can also occur in older individuals due to age-related changes in the knee joint.

• #45 Patellofemoral pain syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/symptoms-causes/syc-20350792

  Patellofemoral pain syndrome can have several causes. It’s been linked with: […] Overuse. Running or jumping sports put repeated stress on the knee joint, which can cause irritation under the kneecap. […] Muscle imbalances or weaknesses. Patellofemoral pain can occur when the muscles around the hip and knee don’t keep the kneecap in line. Moving the knee inward during a squat has been linked to patellofemoral pain. […] Injury. Trauma to the kneecap, such as when the kneecap gets out of place or breaks, has been linked to patellofemoral pain syndrome. […] Surgery. Knee surgery can increase the risk of patellofemoral pain. This is especially true of repair to the anterior cruciate ligament using one’s own patellar tendon as a graft.

• #46 Patellofemoral Pain Syndrome – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/

  Patellofemoral pain syndrome (PFPS) is a broad term used to describe pain in the front of the knee and around the patella, or kneecap. It is sometimes called „runner’s knee” or „jumper’s knee” because it is common in people who participate in sports especially females and young adults but PFPS can occur in nonathletes, as well. […] Many things may contribute to the development of PFPS. Problems with the alignment of the kneecap and overuse from vigorous athletics or training are often significant factors. […] In many cases, PFPS is caused by vigorous physical activities that put repeated stress on the knee such as jogging, squatting, and climbing stairs. It can also be caused by a sudden change in physical activity, which can be related to the frequency of activity (e.g., increasing the number of days you exercise each week) or to the duration or intensity of activity (e.g., running longer distances).

• #47 Patellofemoral pain syndrome (runner’s knee): Treatment and more

  https://www.medicalnewstoday.com/articles/319458

  Age: Adolescents and young adults are at the highest risk of patellofemoral syndrome, although it may also affect older adults. […] Sex: Women are more likely than men to develop this condition, possibly due to greater risk of muscle imbalance and the wider angle of the female pelvis. […] High-impact activities: Engaging in high-impact or weight-bearing activities, including running, jumping, or squatting causes repetitive stress to the joints, and increases the risk of knee injury. […] Flat feet: People with flat feet may be at higher risk of patellofemoral syndrome as they place additional stress on their knee joints.

• #48 Patellofemoral Pain Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0115/p88.html

  Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults younger than 60 years. The cardinal feature of PFPS is pain in or around the anterior knee that intensifies when the knee is flexed during weight-bearing activities. […] Patellofemoral pain syndrome (PFPS) is a common cause of knee pain in adolescents and adults younger than 60 years. […] Established risk factors for PFPS include female sex and activities such as running, squatting, and going up and down stairs. […] Dynamic valgus is another mechanism associated with PFPS. Dynamic valgus is a body position in which the knee collapses medially from excessive valgus, internal-external rotation, or both. […] Patellar maltracking is believed to play a role in PFPS. Patellar maltracking, or lateral translation, increases with load-bearing positions, such as squatting, in patients with PFPS.

• #49 Patellofemoral Pain Syndrome (Runner’s Knee) | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/knee/patellofemoral-pain-syndrome

  Patellofemoral pain syndrome is an umbrella term for pain under or around the patella (kneecap). […] The cause of patellofemoral pain syndrome can’t always be identified, but knee alignment or gait may contribute to the pain. […] PFPS can be caused by problems with kneecap alignment, a kneecap too high in the knee joint, weak thigh muscles, tight hamstrings, a tight Achilles tendon, weak muscles supporting the knee, and muscle imbalances. […] Females are twice as likely to experience PFPS. Athletes playing on hard surfaces and using improper footwear may be prone to patellofemoral pain syndrome. […] A kneecap injury can also be a risk for developing PFPS. […] Children and young adults more commonly experience pain from patellofemoral pain syndrome.

• #50 Patellofemoral Pain Syndrome | NHS Lanarkshire

  https://www.nhslanarkshire.scot.nhs.uk/services/physiotherapy-msk/patellofemoral-pain-syndrome/

  Patellofemoral Pain Syndrome (PFPS) is the name given to a common knee condition which causes pain at the front of the knee around the area known as the patellofemoral joint. […] PFPS usually occurs without an injury to the knee, but can very occasionally be as a result of an injury, such as a fall onto the knee. If you have not injured your knee, it may be difficult to find one specific cause of your PFPS, as it often occurs for a number of reasons. These include: […] Being overweight can contribute to this condition so maintaining a healthy weight can help reduce pain. […] Weight Reduction People who are overweight tend to have more prolonged pain and poorer tissue healing due to increased levels of inflammation in the body. Reducing your weight can generally help improve the healing process.

• #51 Patellofemoral Pain Syndrome – Everything You Need to Know

  https://centenoschultz.com/condition/patellofemoral-pain-syndrome/

  Obesity, being overweight, or having a high BMI of over 25, can increase the load on the knee joint, leading to patellofemoral syndrome. […] A fall or direct trauma to the patella can injure the patella and knee joint, leading to inflammation of the patellofemoral joint. […] There is a correlation between foot pressure and the knee joint. […] Studies have found that limited dorsiflexion of the ankle can lead to compensatory movements in the knee during activities like squatting, lunging, or going up stairs. […] Muscle strength is critical for proper patellofemoral joint health and function because the muscles around the knee joint help stabilize and support it. […] Increased body mass index (BMI) is a risk factor for developing patellofemoral pain syndrome as it puts extra stress on the knee joint during weight-bearing activities.

• #52 Patellofemoral Pain Syndrome: Causes and Treatment Exercises – Martin Koban

  https://martinkoban.com/patellofemoral-pain-syndrome/

  Patellofemoral Pain Syndrome can occur in athletes and non-athletes. Its exact causes remain unclear, even to this day, which is why it is also described as a black hole in orthopedic medicine. Yet, we do have a list of potential causes: Patellar maltracking, Muscle weakness (e.g., quads, hip abductors and external rotators, trunk side flexors), Delayed vastus medialis muscle activation, strength, or morphology, Lack of flexibility of leg muscles (e.g., calves, hamstrings, and quads), Overpronation, Prolonged and excessive forces pulling on the patella in lateral direction, Abnormal femoral, tibial, or foot rotation, Excessive hip adduction during movement, Misalignment of the hip during movement (e.g., contralateral pelvic drop), Reduced strength and or motor control of the trunk and core muscles, Anatomical factors (e.g., patella alta, hypoplasia of medial patellar facet, shallow trochlear groove, femoral anteversion and inclination), Overloaded medial stabilization structures (retinaculum) in the knee due to excessive lateral forces, Faulty running technique, Female gender, Reduced blood flow in or around the kneecap, Reduced proprioception, Reduced extension ability of the big toe. […] To a large extent it remains unclear which of these factors are causative and which are the result of activity reduction due to pain. […] Additionally, causes of patellofemoral pain syndrome are likely different between genders and even in one gender, different subgroups of PFPS likely exist.

• #53 Kneecap Pain | Patellofemoral Pain. What are the causes?

  https://www.physioclinic.ie/conditions/kneecap-pain/

  Research by Witvrouw et al. (2000) found four potential predictors for patellofemoral pain: Delayed quadriceps response time, A decrease in explosive strength, A shortened quadriceps, A hypermobile patella. […] Other risk factors identified in the research include: Gender: females are at greater risk, Training load: increased training load is associated with increased risk of PFP, Navicular drop. The navicular is a large bone on the inside of the foot. A drop may indicate poor foot biomechanics, Tightness of the gastrocnemius (calf) muscle. […] Although most experts discuss the erosion of the cartilage behind the kneecap as the source of injury in patellofemoral pain, in scientific experiments the cartilage itself was shown to be pain-free. The outer surface of the bone (subchondral bone) is highly innervated and has been shown to be a source of pain along with the fluid lining the knee joint (called synovial fluid). There is also a fat pad below the kneecap known as the infrapatellar or Hoffer’s fat pad which is thought to be a strong source of knee pain.

• #54 Patellofemoral pain syndrome – pain in the kneecap | medi

  https://www.medi.de/en/diagnosis-treatment/knee-pain/patellofemoral-pain-syndrome/

  The term patellofemoral pain syndrome (PFPS) is used to define pain in the patellar groove between the thigh and the kneecap. […] Patellofemoral pain syndrome is most prevalent among young women. This is because when the body is still developing, the muscles and bones very frequently do not grow at the same rate. Moreover, the increased prevalence of misalignments (knock knees), hormonal aspects and a reduction in physical activity also play a role. […] The most common causes include shortened or weakened thigh muscles, an incompletely formed kneecap groove, a leg axis deviation (such as knocked knees or bow legs) or even tilting of the kneecap. […] From the anatomical viewpoint, these include anomalies of the patellar groove or the shape of the patella. Other risk factors include a lax ligamentous apparatus (hypermobility of the kneecap), a high patella and an imbalance between the inner and the outer muscles over the front of the thigh.

• #55 Anterior Knee Pain: Causes and Treatment | Doctor

  https://patient.info/doctor/anterior-knee-pain

  Patellofemoral pain syndrome (PFPS) is a diagnosis of exclusion and is defined as pain behind or around the patella. […] PFPS seems to be multifactorial, resulting from a complex interaction between intrinsic anatomy and external training factors. Pain and dysfunction often result from either abnormal forces or prolonged repetitive compressive or shearing forces between the patella and the femur at the PFJ. […] The potential causes of PFPS remain controversial but include overuse, overloading and misuse of the PFJ. Underlying causes of PFPS include: Overuse of the knee – eg, in sporting activities. […] Overuse seems to be the most significant risk factor as well as early sport specialisation. PFPS is 1.5 times more common in young people concentrating on one sport compared with those who take part in multiple sports.

• #56

  https://www.hingehealth.com/resources/articles/patellofemoral-pain-syndrome/

  Patellofemoral pain syndrome is a broad term that encompasses many different factors that cause knee pain, says Dr. Stewart. […] Here are some of the most common reasons you may experience patellofemoral pain syndrome: […] Too much activity, too soon. When you do more than your body is used to, it could lead to pain. […] Injury. Sometimes, simply bumping your knee or experiencing other acute injuries can result in ongoing pain. […] Muscle weaknesses or imbalances. Strong, balanced muscles distribute stress more evenly, taking pressure off joints like your knees. […] Foot issues. Overpronating (rolling in too much) when you walk or run can increase stress on the knees and may contribute to patellofemoral pain syndrome. […] Tight muscles. Limited range of motion from tight muscles can cause changes in walking and running patterns, resulting in increased knee pain. […] Lifestyle factors. While they may not be the primary cause of patellofemoral pain syndrome, factors like stress, poor sleep, and anxiety can contribute to knee pain and worsen it.

• #57 Patellofemoral pain syndrome – Treat the cause, not the symptoms

  https://www.exakthealth.com/en-US/blog/patellofemoral-pain-syndrome-treat-the-cause-not-the-symptoms

  Patellofemoral pain syndrome can have many causes, each requiring a slightly different treatment approach. […] Patellofemoral pain syndrome refers to pain felt in and around the kneecap. It’s usually caused by one or more of the structures in the patellofemoral joint becoming inflamed or irritated. […] Patellofemoral pain syndrome is an overuse injury that develops when the forces you place on your patellofemoral joint are higher than it can cope with. […] This overuse or overload can happen suddenly, during one training session or activity, or gradually accumulate over several sessions. […] Poor movement patterns cause your kneecap to move in suboptimal ways. […] Weak thigh muscles increase the force on the patellofemoral joint. […] A too sudden increase in activity e.g., walking, running, or jumping.

• #58 Patellofemoral Pain Syndrome (PFPS): Causes and Considerations for Triathletes in Toronto

  https://www.bodiempowerment.com/patellofemoral-pain-syndrome-pfps-causes-and-considerations-for-triathletes-in-toronto/

  Patellofemoral Pain Syndrome (PFPS), commonly known as runners knee, is prevalent among triathletes and is characterized by pain around or behind the kneecap. This discomfort often intensifies during running, squatting, climbing stairs, or prolonged sitting. […] Overuse and Repetitive Stress: High-impact activities such as running, cycling, and swimming can subject the knee joint to repetitive stress, leading to irritation under the kneecap. As noted by the Mayo Clinic, this overuse is a primary contributor to patellofemoral pain syndrome (PFPS). Repetitive motion and impact can strain the knee structures, causing pain and discomfort over time. […] Muscle Imbalances or Weaknesses: Weakness or tightness in the quadriceps muscles, especially the vastus medialis obliquus (VMO), can disrupt proper kneecap tracking, increasing the risk of PFPS. Similarly, weak hip abductors and external rotators can alter biomechanics, placing additional stress on the knee joint. This imbalance can cause improper alignment and movement patterns, exacerbating knee pain.

• #59 Patellofemoral Pain Syndrome | Runner’s Knee | OrthoCarolina

  https://www.orthocarolina.com/media/patellofemoral-pain-syndrome-runners-knee-what-to-know

  Patellofemoral pain syndrome (PFPS) pain can be multifactorial, coming from a number of places. It can occur for these reasons, among others: […] The cause of PFPS pain can be multifactorial, coming from a number of places. It can occur for these reasons, among others: Natural posture: patellar position, knee position (being knock-kneed); Weakness in your core, gluteus or thigh muscles; Tightness in the hip, thigh or calf; Improper training; Starting a physical activity without proper warm-up; Increasing distance or frequency too quickly when training for a race; Lack of cross training; Improper footwear, including wearing the wrong style running shoe for your body or not changing out your shoe wear often enough. The average running shoe will safely last 300-500 miles.

• #60 Patellofemoral Pain Syndrome | Runner’s Knee | OrthoCarolina

  https://www.orthocarolina.com/media/patellofemoral-pain-syndrome-runners-knee-what-to-know

  Patellofemoral pain syndrome (PFPS) pain can be multifactorial, coming from a number of places. It can occur for these reasons, among others: […] The cause of PFPS pain can be multifactorial, coming from a number of places. It can occur for these reasons, among others: Natural posture: patellar position, knee position (being knock-kneed); Weakness in your core, gluteus or thigh muscles; Tightness in the hip, thigh or calf; Improper training; Starting a physical activity without proper warm-up; Increasing distance or frequency too quickly when training for a race; Lack of cross training; Improper footwear, including wearing the wrong style running shoe for your body or not changing out your shoe wear often enough. The average running shoe will safely last 300-500 miles.

• #61 Patellofemoral Stress Syndrome Causes and Treatment

  https://www.verywellhealth.com/knee-pain-from-patellofemoral-stress-syndrome-2696537

  Patellofemoral stress syndrome, also referred to as patellofemoral pain syndrome (PFPS), is so-named because it occurs at the junction of the patella (kneecap) and femur (thigh bone), known as the patellofemoral joint. […] PFSS is commonly referred to as runner’s knee and jumper’s knee because it is most frequently seen in athletes who run or jump. The recurrent stress placed on the knee with sports can start to weaken the rubbery „shock absorbers” of the knee, called menisci. It can also weaken the articular cartilage covering the end of the femur and the underside of the patella. […] Over time, recurrent stress on the knee can cause the inflammation of nerves in the knee capsule, leading to anterior (frontal) knee pain. […] Additional risk factors for PFSS include: Sudden changes in activity levels: Examples include increasing the distance or duration of long-distance running or increasing the frequency of high-intensity workouts. Structural misalignment of the knee: Such misalignment, which can occur naturally or after an injury, places greater stress on one knee in order to compensate for the imbalance. Improper training: Improper training of the lower body and core muscles can create imbalances in the hips and thighs that make the knees more vulnerable to stress-related injury. Changes in footwear: Even minor changes in heel elevation or arch support can alter how your feet strike the ground, placing unexpected stress on the patellofemoral joint. Changes in surfaces: Switching from a grass tennis court to a hard tennis court, for instance, can stress the knee if you are unable to adjust how your feet strike the new surface. Chondromalacia patellae: This is a condition that causes the breakdown of cartilage on the underside of the kneecap, causing it to rub against the thigh bone.

• #62 Patellofemoral Pain Syndrome Symptoms & Treatment | UPMC

  https://www.upmc.com/services/orthopaedics/conditions/patellofemoral-pain

  Patellofemoral pain syndrome occurs when your patella (kneecap) cartilage becomes overloaded due to overuse, often caused by high-impact activities, or as a result of poor alignment. […] You are more likely to develop patellofemoral pain syndrome if you play high-impact sports such as football, basketball, soccer, and tennis, or if you are a runner. […] These activities all have the potential to aggravate the patella cartilage. In addition, running on uneven surfaces, like hills or trails, or playing on multiple surfaces (such as hard and clay courts in tennis) also may increase the likelihood of patellofemoral pain.

• #63 Patellofemoral pain syndrome: causes and solutions

  https://epitact.co.uk/knee/patellar-syndrome/patellofemoral-pain-syndrome-causes

  Psychological factors also have a link with chronic patellofemoral pain syndrome. They include anxiety, depression and kinesiophobia, which is the fear of pain caused by moving. […] Other than anatomy, sports practice can also explain the onset of patellofemoral pain syndrome. Indeed, knee overuse after excessive loads on the patellofemoral joint often causes PFPS. […] Any activity that involves high pressure between the patella and the femur or repeated stress on the joint (especially when the knees are bent) can cause patellofemoral pain syndrome. […] Activities with repeated flexion/extension movements of the knee (running, brisk walking, skiing…) stand among the major causes of patellofemoral pain syndrome. […] The type of sports: in the general population, 16 to 25% of runners have patellofemoral pain syndrome. […] Shoes, especially high heels increase the stress on the patellofemoral joint. […] Previous kneecap trauma and complications of ligament or meniscus surgery.

• #64 Patellofemoral Pain Syndrome (PFPS): Causes and Considerations for Triathletes in Toronto

  https://www.bodiempowerment.com/patellofemoral-pain-syndrome-pfps-causes-and-considerations-for-triathletes-in-toronto/

  Improper Training Techniques: Sudden training intensity or duration increases without adequate preparation can strain the knee joint. Rapid escalation in physical activity can overwhelm the knees ability to adapt, leading to PFPS. Additionally, poor running form, such as excessive foot pronation or supination, can contribute to the development of PFPS by causing uneven stress distribution across the knee joint. […] Structural Abnormalities: Flat feet, or pes planus, can lead to improper knee alignment, increasing stress on the patellofemoral joint. This structural issue can result in the knee compensating for the lack of proper foot support, thus aggravating PFPS. Kneecap misalignment, such as patellar maltracking, can predispose individuals to PFPS by causing uneven wear and tear on the knee structures.

• #65 Patellofemoral Pain Syndrome | Runner’s Knee | OrthoCarolina

  https://www.orthocarolina.com/media/patellofemoral-pain-syndrome-runners-knee-what-to-know

  Patellofemoral pain syndrome (PFPS) pain can be multifactorial, coming from a number of places. It can occur for these reasons, among others: […] The cause of PFPS pain can be multifactorial, coming from a number of places. It can occur for these reasons, among others: Natural posture: patellar position, knee position (being knock-kneed); Weakness in your core, gluteus or thigh muscles; Tightness in the hip, thigh or calf; Improper training; Starting a physical activity without proper warm-up; Increasing distance or frequency too quickly when training for a race; Lack of cross training; Improper footwear, including wearing the wrong style running shoe for your body or not changing out your shoe wear often enough. The average running shoe will safely last 300-500 miles.

• #66 Patellofemoral pain syndrome: causes and solutions

  https://epitact.co.uk/knee/patellar-syndrome/patellofemoral-pain-syndrome-causes

  Psychological factors also have a link with chronic patellofemoral pain syndrome. They include anxiety, depression and kinesiophobia, which is the fear of pain caused by moving. […] Other than anatomy, sports practice can also explain the onset of patellofemoral pain syndrome. Indeed, knee overuse after excessive loads on the patellofemoral joint often causes PFPS. […] Any activity that involves high pressure between the patella and the femur or repeated stress on the joint (especially when the knees are bent) can cause patellofemoral pain syndrome. […] Activities with repeated flexion/extension movements of the knee (running, brisk walking, skiing…) stand among the major causes of patellofemoral pain syndrome. […] The type of sports: in the general population, 16 to 25% of runners have patellofemoral pain syndrome. […] Shoes, especially high heels increase the stress on the patellofemoral joint. […] Previous kneecap trauma and complications of ligament or meniscus surgery.

• #67 Patellofemoral pain syndrome: causes and solutions

  https://epitact.co.uk/knee/patellar-syndrome/patellofemoral-pain-syndrome-causes

  Psychological factors also have a link with chronic patellofemoral pain syndrome. They include anxiety, depression and kinesiophobia, which is the fear of pain caused by moving. […] Other than anatomy, sports practice can also explain the onset of patellofemoral pain syndrome. Indeed, knee overuse after excessive loads on the patellofemoral joint often causes PFPS. […] Any activity that involves high pressure between the patella and the femur or repeated stress on the joint (especially when the knees are bent) can cause patellofemoral pain syndrome. […] Activities with repeated flexion/extension movements of the knee (running, brisk walking, skiing…) stand among the major causes of patellofemoral pain syndrome. […] The type of sports: in the general population, 16 to 25% of runners have patellofemoral pain syndrome. […] Shoes, especially high heels increase the stress on the patellofemoral joint. […] Previous kneecap trauma and complications of ligament or meniscus surgery.

• #68 Patellofemoral Syndrome: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/308471-overview

  Moreover, load-bearing positions, as assumed in squatting and stair climbing, increase maltracking in patients with PFS. […] Excessive use of the joint with regard to either frequency or amount of loading also contributes to the symptoms. […] Psychological stress, chronic pain, and central sensitization may play a role in PFS.

• #69 Patellofemoral Syndrome: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/308471-overview

  Moreover, load-bearing positions, as assumed in squatting and stair climbing, increase maltracking in patients with PFS. […] Excessive use of the joint with regard to either frequency or amount of loading also contributes to the symptoms. […] Psychological stress, chronic pain, and central sensitization may play a role in PFS.

• #70

  https://www.hingehealth.com/resources/articles/patellofemoral-pain-syndrome/

  Patellofemoral pain syndrome is a broad term that encompasses many different factors that cause knee pain, says Dr. Stewart. […] Here are some of the most common reasons you may experience patellofemoral pain syndrome: […] Too much activity, too soon. When you do more than your body is used to, it could lead to pain. […] Injury. Sometimes, simply bumping your knee or experiencing other acute injuries can result in ongoing pain. […] Muscle weaknesses or imbalances. Strong, balanced muscles distribute stress more evenly, taking pressure off joints like your knees. […] Foot issues. Overpronating (rolling in too much) when you walk or run can increase stress on the knees and may contribute to patellofemoral pain syndrome. […] Tight muscles. Limited range of motion from tight muscles can cause changes in walking and running patterns, resulting in increased knee pain. […] Lifestyle factors. While they may not be the primary cause of patellofemoral pain syndrome, factors like stress, poor sleep, and anxiety can contribute to knee pain and worsen it.

• #71 Patellofemoral Pain Syndrome (Runner’s Knee) | University of Utah Health

  https://healthcare.utah.edu/orthopaedics/specialties/knee-pain/patellofemoral-pain

  Patellofemoral pain syndrome occurs when nerves sense pain in the soft tissues and bone around the kneecap. […] In some cases of patellofemoral pain, a condition called chondromalacia patella is present. […] Chondromalacia patella is the softening and breakdown of the articular cartilage (cartilage that covers the ends of bones) on the underside of the kneecap. […] There are no nerves in articular cartilage so damage to the cartilage itself cannot directly cause pain. It can, however, lead to inflammation and pain in the underlying bone.

• #72 Kneecap Pain | Patellofemoral Pain. What are the causes?

  https://www.physioclinic.ie/conditions/kneecap-pain/

  Research by Witvrouw et al. (2000) found four potential predictors for patellofemoral pain: Delayed quadriceps response time, A decrease in explosive strength, A shortened quadriceps, A hypermobile patella. […] Other risk factors identified in the research include: Gender: females are at greater risk, Training load: increased training load is associated with increased risk of PFP, Navicular drop. The navicular is a large bone on the inside of the foot. A drop may indicate poor foot biomechanics, Tightness of the gastrocnemius (calf) muscle. […] Although most experts discuss the erosion of the cartilage behind the kneecap as the source of injury in patellofemoral pain, in scientific experiments the cartilage itself was shown to be pain-free. The outer surface of the bone (subchondral bone) is highly innervated and has been shown to be a source of pain along with the fluid lining the knee joint (called synovial fluid). There is also a fat pad below the kneecap known as the infrapatellar or Hoffer’s fat pad which is thought to be a strong source of knee pain.

• #73 Patellofemoral Pain Syndrome (Runner’s Knee) | University of Utah Health

  https://healthcare.utah.edu/orthopaedics/specialties/knee-pain/patellofemoral-pain

  Patellofemoral pain syndrome occurs when nerves sense pain in the soft tissues and bone around the kneecap. […] In some cases of patellofemoral pain, a condition called chondromalacia patella is present. […] Chondromalacia patella is the softening and breakdown of the articular cartilage (cartilage that covers the ends of bones) on the underside of the kneecap. […] There are no nerves in articular cartilage so damage to the cartilage itself cannot directly cause pain. It can, however, lead to inflammation and pain in the underlying bone.

• #74 Patellofemoral Pain Syndrome – Symptoms, Causes, Treatment & Exercise

  https://www.sportsinjuryclinic.net/anterior-knee-pain/patellofemoral-pain-syndrome

  Patellofemoral Pain Syndrome (PFPS) results from the patella (kneecap) rubbing on the femur bone underneath. […] The initial cause of patellofemoral pain syndrome is likely to be overused. This may be from external factors, for example, a sudden increase in training. Or it is from internal factors such as poor patella tracking. Identifying the cause is an important part of treatment. […] It can have a number of causes but damage to the cartilage itself cannot directly cause pain. This is because there are no blood vessels or nerves involved. However, it can lead to other problems which in turn result in pain. These include: Synovitis or inflammation of the synovial membrane surrounding the joint. Erosion of the cartilage and eventually the bone. Soft tissue injury, for example to the lateral retinaculum or patella fat pad.

• #75 Kneecap Pain | Patellofemoral Pain. What are the causes?

  https://www.physioclinic.ie/conditions/kneecap-pain/

  Research by Witvrouw et al. (2000) found four potential predictors for patellofemoral pain: Delayed quadriceps response time, A decrease in explosive strength, A shortened quadriceps, A hypermobile patella. […] Other risk factors identified in the research include: Gender: females are at greater risk, Training load: increased training load is associated with increased risk of PFP, Navicular drop. The navicular is a large bone on the inside of the foot. A drop may indicate poor foot biomechanics, Tightness of the gastrocnemius (calf) muscle. […] Although most experts discuss the erosion of the cartilage behind the kneecap as the source of injury in patellofemoral pain, in scientific experiments the cartilage itself was shown to be pain-free. The outer surface of the bone (subchondral bone) is highly innervated and has been shown to be a source of pain along with the fluid lining the knee joint (called synovial fluid). There is also a fat pad below the kneecap known as the infrapatellar or Hoffer’s fat pad which is thought to be a strong source of knee pain.

• #76 Patellofemoral Syndrome: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/308471-overview

  Patellofemoral syndrome (PFS) is characterized by a group of symptoms that contribute to anterior knee pain. The pain is associated with positions of the knee that result in increased or misdirected mechanical forces between the patella (kneecap) and femur. […] While there are several factors associated with this syndrome, there is a lack of consensus regarding the cause. […] Overall, PFS is thought to be associated with a combination of anatomic, biomechanical, behavioral, and psychological factors. […] While theories regarding the pathophysiology of PFS vary, the prevailing theory is that the syndrome is caused by abnormal tracking and alignment of the patella due to an imbalance of ligamentous and muscle forces as well as malalignment between the joint surfaces. […] Patellar maltracking leads to irritation of the richly innervated nerve endings within the retinaculum, subchondral bone, Hoffa (infrapatellar) fat pad, and peripatellar synovium.

• #77 Patellofemoral Pain Syndrome – Symptoms, Causes, Treatment & Exercise

  https://www.sportsinjuryclinic.net/anterior-knee-pain/patellofemoral-pain-syndrome

  Patellofemoral Pain Syndrome (PFPS) results from the patella (kneecap) rubbing on the femur bone underneath. […] The initial cause of patellofemoral pain syndrome is likely to be overused. This may be from external factors, for example, a sudden increase in training. Or it is from internal factors such as poor patella tracking. Identifying the cause is an important part of treatment. […] It can have a number of causes but damage to the cartilage itself cannot directly cause pain. This is because there are no blood vessels or nerves involved. However, it can lead to other problems which in turn result in pain. These include: Synovitis or inflammation of the synovial membrane surrounding the joint. Erosion of the cartilage and eventually the bone. Soft tissue injury, for example to the lateral retinaculum or patella fat pad.

• #78 Patellofemoral Pain Syndrome treatments CT | OAH

  https://oahct.com/direct-orthopedic-care/knee-pain-orthopedic-specialist/patello-femoral-syndrome-symptoms-and-treatments/

  Kneecap pain is one of the most common symptoms experienced by athletes. Studies have shown that patellofemoral pain syndrome comprises up to 50% of overuse injuries. This syndrome is caused by irritation of the undersurface of the patella (kneecap) which, in its normal state, is smooth. The irritation can lead to a roughening of the patella undersurface, a condition called chondromalacia. […] Pain is caused by pressure between the patella and the groove in the femur. As you bend your knee, you gradually increase the pressure and stress between the patella and the femur. The irritation and roughening of the patella causes inflammation, which leads to pain and swelling. […] When the patella is not symmetrical in the femoral groove, there is an imbalance resulting in wear and tear. An asymmetrical kneecap is called a “jockey cap” patella. This condition can be identified on x-rays. […] Overuse (especially downhill running) […] Previous injury to the knee.

• #79 Patellofemoral Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557657/

  Patellofemoral syndrome (PFS) is one of the most common causes of anterior knee pain. […] The etiology of patellofemoral syndrome is without a clear consensus; however, it is likely multifactorial and secondary to training practices. It is thought to involve 6 anatomic areas, including subchondral bone, synovium, retinaculum, skin, nerve, and muscle. […] Studies point to four major contributing factors: malalignment of the lower extremity and/or patella, muscular imbalance of the lower extremity, overactivity/overload, and trauma. […] Of the four contributing factors, overuse appears to be the most important. […] Many patients with PFS do not demonstrate any signs of malalignment. Instead, during careful interviewing, overload of the patellofemoral joint is often described, which can lead to the development of PFS. […] Direct or indirect injuries to the patellar area can damage structures leading to PFS. […] Though studies have pointed to the above causes or risks of developing patellofemoral syndrome, most will agree its development is rarely secondary to a single component.

• #80

  https://link.springer.com/article/10.1007/s40141-014-0044-3

  The pathophysiology of PFPS is thought to be multifactorial. It is likely that a combination of biomechanical factors along with muscle and soft tissue imbalances lead to improper tracking of the patella in the trochlea of the femur, eventually leading to increased stress at the patellofemoral joint. […] Other causes of anterior knee pain that must be considered, but occur by different mechanisms, include osteochondral lesions, avulsion fractures, plica, osteoarthritis, patellar and quadriceps tendinitis, bursitis, apophysitis, tendon rupture, patellar fracture, symptomatic bipartite patella, contusion, bone tumor and CRPS. […] Successful management of PFPS patients involves classification through examination to identify individual local, distal and proximal contributing factors.

• #81 Patellofemoral Pain Syndrome (PFPS): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17914-patellofemoral-pain-syndrome-pfps

  Patellofemoral pain syndrome (PFPS) is knee pain under or around your patella (kneecap). Experts arent certain what causes it, but you can usually treat it with the RICE method, physical therapy and by slowly ramping up your activity level. […] Patellofemoral pain syndrome usually develops over time. […] Experts arent sure exactly what causes PFPS. Some factors or issues that may cause it include: Overusing your knees: Doing the same kind of motion often (like jumping a lot or working on your hands and knees) might cause PFPS. Weak or tight muscles around your knee: If the muscles in your legs around your knee (especially your quad muscles) are weak, they might not be able to support your knee as they should. Similarly, if your quads and other muscles arent flexible enough, they can put too much tension on your knee. Suddenly increasing your activity level: You might develop PFPS if you start a new sport or activity or increase how often youre active. PFPS might also happen if you increase the intensity of your practices or training. The natural shape of your knee: If your patella is naturally an unusual shape or doesnt fit into the groove in your femur as it should, you might develop PFPS without any extra stress or strain on your knees. […] PFPS usually gets worse over time if its not diagnosed and treated. On top of increasing pain, untreated PFPS may increase your risk of injuries.

• #82

  https://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/Knee-Pain-and-Patellofemoral-Pain-Syndrome.aspx

  Patellofemoral pain syndrome is one of the most common causes of knee pain in young athletes. The condition is an overuse injury that results from activities that cause pressure or friction on the cartilage behind the kneecap. Patellofemoral pain syndrome occurs frequently in athletes who participate in sports that involve running, jumping, or squatting. […] People with flatfeet, intoeing, or knock-knees may be at higher risk for this condition because these conditions affect how the kneecap tracks. Athletes with tight hamstring and quadriceps muscles or weak thigh and hip muscles may also be at risk because of the effect these abnormalities have on pressure on the kneecap or tracking. […] The key to resolving patellofemoral pain syndrome is identifying and correcting the causes of the pain. The treatment for a particular individual with patellofemoral pain syndrome will depend on which of these causes seems to be contributory.

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