Patellofermoral Pain Syndrome, also called retropatella pain, is successfully treated in more than 2/3 of cases with conservative treatments including rehabilitation. The goal of these programs should be to reduce pain and restore function of the foot, knee, and hip. A classic sign of PFPS is pain in the knees while sitting for long periods of time and reduction of pain when standing.
The exact cause of patellafemormal pain syndrome is debated by many different specialists. Many believe that weakness in the VMO or medial/inside quad muscle causes abnormal movement of the knee cap and leads to pain and dysfunction. Exercises to strengthen the VMO are commonly preformed but these exercises only make the underlying dysfunction worse.
Current research shows that the true cause of PFPS is not the abnormal movement of the knee cap but the abnormal movement of the femur under the knee cap. This abnormal movement is caused by weakness in the hip muscles, which allow increased inward movement of the leg. Not only the hip but the foot can increase one’s risk of developing PFPS. Loss of motion of the ankle joint or major excessive pronation or supination of the foot can increase the stress on the knee and lead to pain under the knee cap. Braces and straps can help decrease symptoms.
Lower cross syndrome is named for the crossing tightness and weakness that occurs in the lower back, core, and hip muscles. In LCS, tightness of the low back muscles crosses with tightness of the iliopsoas (hip flexors) and rectus femoris (main quad muscle). Weakness of the deep abdominal muscles crosses with weakness of the gluteus maximus and medius.
This pattern of imbalance creates joint dysfunction, particularly in the lumbar spine, pelvis, hips, and knees. Specific postural changes seen in LCS include anterior pelvic tilt, increased lumbar curve, and knee straightening. Stress is increased on the low back and hips due to tight muscles and can cause pain in the low back when running, walking, and standing for long periods of time.
LCS is common in females, individuals that sit for most of the day and individuals that perform repetitive activities such as running and jumping. Many common injuries that plaques the active person can stem from LCS. Treatments for lower cross syndrome consist of postural training, Active Release/Graston on overactive muscles, and rehab exercises for underactive muscles. Additional home treatments for Lower Cross are foam rolling the quad and anterior hip muscles, Nature Made High Potency Magnesium 400 mg – 150 Liquid Softgels
for overactive and sore muscles, and anti-inflammatory nutrition for proper healing. Anti-inflammtory book.
In Lower Cross Syndrome the anterior hip is chronically tight and lacks motion due to muscle overactivity and posture. If one can not move through the anterior hip, the low back has to become hypermobile or have too much motion. This can lead to low back pain and inhibition or weak core muscles.
The anterior hip consists of the large muscle of the quadriceps, Rectus Femoris, and the large hip flexor, Psoas. When these muscles become chronically tight, the anterior hip capsule or ligaments begin to shorten. Now the hip can not translate or move through its proper range of motion and the gluts are put into a weakened, elongated state. The lumbar spine compensates by increasing its curve which causes the core muscles to weaken and shut off.
This process leads to overuse of the low back and pain, glut and core weakness, and hip impingements. If you have hip or low back pain, and/or Lower Cross Syndrome the click here to see this weeks exercises.