In a 1999 issue of The American Family Physician, Dr. Mark Juhn published an article called, Patellofemoral Pain Syndrome: A Review and Guidelines for Treatment. In his article, Dr. Juhn said the following:
Managing patellofemoral pain syndrome is a challenge, in part because of lack of consensus regarding its cause and treatment. Contributing factors include overuse and overload of the patellofemoral joint, biomechanical problems and muscular dysfunction….. Footwear should be closely evaluated for quality and fit, and the use of arch supports should be considered.
In world where EVIDENCE-BASED MEDICINE is the catchword du jour, it is rather disheartening that there is no real consensus as to the cause or treatment of Palellofemoral Syndrome — also known as Patellar Tracking Syndrome (the number one reason people visit sports medicine physicians). And even though nearly two decades have passed since Juhn wrote those words, they are just as true today.
The standard medical fare for dealing with Patellar Tracking Syndrome involves rest and stretching / strengthening exercises. Some clinicians are having good luck with various taping procedures. None of this is bad in the short term. However, it’s not a viable long-term solution. When these don’t work, NSAIDS, or God forbid, corticosteroids are thrown into the mix (HERE), typically causing more harm than good (see link).
When drugs don’t work for this problem (they never really do), the next step is surgery — a Lateral Release. A Lateral Release is nothing more than cutting the overly tight “LATERAL RETINACULUM” on the outer portion of the knee cap. The retinaculum are essentially wide tendons that can, just like any other tendon in the body, develop what’s known as an “OSIS“. Why surgically excise this tissue if it can be ‘released’ in a better (less invasive) way?
Surgery-first remedies are all about the money. Stretching, strengthening, taping, and any number of other treatments for the knee are fine, but are not really effective until the microscopic scarring and underlying adhesion is dealt with via TISSUE REMODELING. Before you spend MONTHS IN THERAPY or try a LATERAL RELEASE SURGERY, see me first. Bear in mind that there might be underlying biomechanical issues that will need to be dealt with (flat feet, weak muscles, etc).