One of the most common knee problems is the improper tracking of the patella (kneecap). This condition is commonly referred to as patello-femoral syndrome. It affects women more than men and is most common in adolescent girls and runners.


There are a number of factors that cause the patella to come off track, of which overpronation of the foot is most common. Overpronation is where the arch of the foot collapses excessively during the gait cycle. However, more times than not, overpronation is itself the symptom of other factors.


Additional factors that contribute to overpronation and patello-femoral syndrome include weakness of the smaller gluteus muscles (gluteus medius and minor), medial quadriceps and anterior tibialis muscles, tightness in the iliotibial band, hamstrings and calf muscles and is occasionally complicated by a misaligned pelvis.


As the name implies, patello-femoral syndrome is a combination of signs and symptoms associated with the patella and the femur (thigh bone).  As the patella has to glide between the condyles of the femur (the two knobby ends of the thigh bone), its underlying cartilage is vulnerable to cumulative wear and tear, particularly if there has been direct trauma to the patella. In most cases the patella slowly starts to track on the outer (lateral) condyle, wearing out the undersurface cartilage.


This happens secondary to excessive internal rotation of the hip and overpronation during the gait cycle causing the knee to track improperly. The internal rotation of the hip is secondary to the weakness and tightness inventoried above. If left uncorrected, it can lead to a breakdown of this cartilage under the patella (a condition called chondromalacia patella), pain and limitation.


The most common symptoms associated with patello-femoral syndrome is difficulty ascending and descending stairs due to pain, grating or grinding with knee extension and knee pain with prolonged sitting (secondary to extended period of patellar compression against the condyles). If you are experiencing gradually worsening knee pain, particularly if the pain is around the patella, there is a good chance that you are developing patello-femoral syndrome.


To correct the problem, it’s to your benefit to start with a thorough evaluation to determine where the deficiencies are. An evaluation should include gait analysis, assessment of the strength and flexibility of the lower-extremity muscles and pelvic alignment. It’s also important to eliminate the provoking activities until the underlying inefficiencies are corrected. Once an evaluation is completed, it will be far easier to customize a treatment plan.


Podiatrists, physical therapists, sports-rehab chiropractors and sports medicine physicians are usually savvy about assessing for overpronation; however, all the potential factors have to be eliminated for successful outcomes. If you do overpronate, over-the-counter arch supports or custom orthotics can significantly reduce this gait problem. However, this will not automatically eliminate the weakness and tightness that lead to the overpronation in the first place.


Patello-femoral syndrome is one of the most common causes of knee pain in adolescents and adults alike. Eliminating the provoking activity, getting a complete evaluation and correcting the inefficiencies associated with overpronation will give you the best chance of getting back to the activities that you love best.


— Sevak Khodabakhshian is a doctor of chiropractic with Thousand Oaks-based Omega Rehab & Sport, where a team of physical therapists, chiropractors and athletic trainers applies an active-care approach to healthcare. He can be reached for comments, questions or suggestions by e-mail, at