Knee Pain

Patellofemoral pain syndrome (knee pain) is by far one of the most common health conditions among my patients and is experienced by over 2.5 million Americans. Statistics for other countries may be even higher. The good news is that for most people, the common form of Patellofemoral Pain Syndrome (PFS) is treatable with a combination of exercises and massage therapy.

The Greek word “Patella” is kneecap, and “Femur” refers to the thighbone that extends from the hip to the knee. Patella and Femur are two central players in the movement of the egs, and I want you to know these characters well to help you develop a better interaction with them. So, let me tell you about Patella and Femur, and the action they are required to perform in the leg.

The knee is one of the intersections of our bodies. It connects the Femur (the thigh bone) to the two bones coming up from the lower part of our leg called Tibia and Fibula. We must remember that the Knee is a weight-bearing joint, and has corresponding ligaments, tissue, muscle, tendons and fluids to allow it to bear our weight, and to make us move, bend, walk, run, drive, dive, work and lift things.

Patella (the knee cap) is a smooth round bone suffixed on top of our knee joint to help the knee bend, lift and move; and also to protect the knee joint.

When in good health, the Patella and Femur allow us to perform feats of magic with our bodies in aerobics, skating, skiing, running, jogging, jumping, swimming, dancing, walking, sitting or simply standing. When the malfunction occurs however, we may be unable to bend the knee to pick up an object or to climb the stairs, no sitting position provides comfort, and we are confronted with excruciating pain inside and around the knee joint.

What causes the Patella and Femur to Malfunction?

The reasons for the Patella and Femur malfunction are still shrouded in mystery, and though there is no agreement, the consensus is that the Patellofemoral pain Syndrome can be caused by one or all of the following:

1. Overload and Overuse
The overload and overuse of Patellofemoral grove or that of the Knee joint itself, degenerates the processes of the whole leg area. Specifically, it can weaken the famous Quads muscle making it lose its grip on the movement of the knee.

2. Biomechanical Problems:

Foot Pronation, Flat Feet or Pes Planus
In the absence of a supportive medial arch, moving the foot causes an additional compensatory movement of the Tibia or of the Femur, which upsets the natural Patellofemoral mechanism.

High-Arched Foot, Supination or Pes Cavus
A high-arched foot fails to provide enough cushion to the foot when it hits the ground. This puts a lot more stress on Patellofemoral mechanism than it is designed to bear.

Q Angle Variation
Normal Q Angle varies anywhere from 10 to 22 degrees, a Q angle larger than 22 is thought by many of my peers, to be the factor that can predispose anyone to PFS.

3. Muscular Dysfunction

Muscular dysfunction occurs when the muscles in the area of Patellofemoral joint either become weakened or inflexible due to any of the conditions cited above, through an accident, a sports injury or due to ageing.

Treating Patellofemoral Pain Syndrome

Keeping the knee and knee cap healthy is not difficult but it requires consistency. I would recommend the following methods for healthy knees, but remember damages Patellofemoral joint requires the attention of professionals.

Strengthen Quadriceps

Central to treating the Patellofemoral pain syndrome is the effort to strengthen the quadriceps or the Quad muscle that controls the movement in the knee. Many strategies can be employed to take care of it but I have found the most natural is offered by massage therapy. Gentle reviving of overloaded and overused muscles allows fast healing and strengthening of the Quad muscles, sometimes giving fast relief to the body.

Temporary Modifications in Action Routine

I have found it increasingly beneficial for the patients of Patellofemoral Pain Syndrome to take a period of rest from their routine physical activity on temporary basis. This has often led to what is called a spontaneous resolution in some patients whose knee condition improved after resting.

During the rest period, if your condition allows for physical activity, try some low-impact activities such as swimming and floating. Begin with a short period and increase it slowly. I would recommend less than 20% increase in activity per week.

Footwear Quality and Fit

It pays to evaluate your footwear for the quality of support and cushion it provides to the foot, and to make sure that it fits well. Poor quality and misfitting footwear may not be a cause of Patellofemoral Pain Syndrome, but it sure can worsen the condition and make it much more painful.

Ideally, your footwear should support your unique foot situation by providing appropriate support and cushion required by flat feet or by high-arched feet.


Much relief and healing occurs when affected knee is treated with ice. Especially useful after physical activity such as running, jogging, volleyball, basketball, prolonged standing or sitting, ice should only be applied for between 10 to 20 minutes at a time.

Anti Inflammation Drugs

Many athletes and people in occupations that require strenuous physical labor carried out over extended periods of time may end up using anti-inflammatory drugs for temporary relief and to allow themselves to continue to perform. As I discussed in another article on Runners (Link:, continuing to performs with injured body parts is not something I will encourage anyone to do.

Anti inflammatory drugs and over-the-counter pain killers give us the illusion that our damaged body part is okay, setting us up to damage it further. But most of all, I am wary of some of the known side-effects of anti inflammatory drugs and I urge my patients to wait and see, use a massage therapist, use exercise, use rest, and consult your physician before you take any drugs to reduce inflammation or swelling of Patellofemoral joint.

Wellness Tips from Mark Bentz, RMT

This Yogic exercise is proven to be the simplest way to strengthen your feet and leg muscles, bones, joints, ligaments and tendons:

  • Stand on comfortable ground;
  • Straighten your backbone and relax the muscles in your back, shoulders, hips, ankles and toes;
  • Exhale to empty your lungs;
  • Slowly stand on your toes, raising yourself about 6 inches from the ground, slowly filling your lungs with fresh air;
  • Hold yourself and your breath for as long as you are comfortable;
  • Still on your toes, and still slow but exhaling, go down to the standing position but not all the way, stop a touch away from the ground;
  • Exhale and empty the lungs, slowly;
  • Repeat this exercise 10 times to begin, increase by five each week till it is 80. Keep at 80 for maximum health and benefit.
  • Observe and experience the changes each movement brings to your calves and to the inside of Patellofemoral Joint.

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