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PFSS: A fancy acronym for common form of knee pain


hat is Patellofemoral Stress Syndrome (PFSS)? PFSS is generalized pain around the patellofemoral joint, or the kneecap, that is activity related. This is one of the most common overuse injuries for young athletes that we see in our sports medicine clinic. The stress at the patellofemoral joint occurs when the athlete places an excessive amount of force through the front thigh, or quadriceps, muscle. When the force of the quadriceps is too high for the kneecap to absorb, the result is PFSS. This will present as front of the knee pain, most commonly, with running, jumping and during quick direction changes of sports. The kneecap pain can be triggered by walking up and down stairs, and become painful with sitting (having the knee bent) for an extended time. PFSS can occur from repeated bending and straightening of the knee, which can irritate the kneecap and surrounding structures. It has four main causes. Muscle Imbalances: The quadriceps muscle is working overtime because the gluteus (back hip) muscles are weak. This creates an imbalance where the workload is too high for the front thigh, and the back thigh is not supporting the movement demands during landing from a jump, or with propelling the leg in sprinting. Faulty Technique: During the bending phase, or landing phase, with running, jumping, or changing direction, the knee joint will excessively rotate, or cave, inward. This can happen because either the hip or the ankle is not providing the support for the knee. This caving in puts extra stress on the patellofemoral joint. Tightness: Lack of flexibility in the quadriceps can compress the patellofemoral joint, as the patella sits at the very end of the quadriceps tendon. Too much too soon: The training pro-

gram has been too much for the muscles to absorb. This can lead to fatigue due to lack of enough rest or recovery. Training programs that involve multiple teams, excessive jumping, or hill running place the patellofemoral joint at risk for an overuse injury. Initial treatment of PFSS is aimed at reducing pain and inflammation by applying P.R.I.C.E. (protect, REST, ice, compression, elevation). Physical therapy is usually the treatment of choice for PFSS. The physical therapist will give you specific exercises to help with stretching of the muscles around the knee and to strengthen the hip, knee, and foot. ■ If there is a muscle imbalance issue: Strengthen the hip, hamstrings and calf before trying to do any squatting exercises. ■ If there is a faulty technique: Look in a mirror and make sure when you do a shallow squat that your knee does not cave inward. ■ If you are tight: Stretch the quadriceps muscle by pulling your heel towards you buttocks. Do this lying on your stomach to prevent any twisting of the knee or too much arching of the back. ■ Monitor your trainings for the week by writing a log what you do for how long. Limit any jumping or hill running until you can run without pain. Any pain you have is a signal to you that there is too much stress on that structure.

Health Watch Michelle Cappello

Michelle Cappello is a physical therapist for the staff of Sports Medicine For Young Athletes, a division of Children’s Hospital Oakland with a facility also located in Walnut Creek. If you have questions or comments regarding the “Health Watch” column, write the Sports Medicine For Young Athletes staff at

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