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26 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 2 Bony ridge under the patella. Image courtesy of Complete Anatomy. 1 Ridge under patella Current Concepts in Patellofemoral Pain Understanding Joint Mechanics Plays a Key Role in Assessment and Treatment TECHNIQUE By Whitney Lowe ANATOMICAL BACKGROUND PFPS is challenging because it isn't clear what is causing the pain in most cases. 1 However, a good understanding of knee anatomy and mechanics helps identify key contributors to the problem. The first place to start is with the knee extensor muscle group. The large and powerful quadriceps femoris muscle group is responsible for knee extension. While extension occurs at the tibiofemoral joint (between the femur and tibia), a third bone, the patella, is an integral part of power generation for this movement. The patella has a bony ridge on its underside (Image 1). That ridge fits in the groove between the two femoral condyles. The patella moves superiorly and inferiorly during flexion and extension, and the bony ridge tracks in a groove formed by the femoral condyles. The patella is a sesamoid (floating) bone embedded in the quadriceps (patellar) tendon. Interestingly, babies are born without a patella. The bone develops in the tendon as the baby gradually starts increasing load through weight-bearing and standing. Anatomy books primarily show the four quadriceps muscles blending into the patellar tendon and attaching to the tibial tuberosity. However, force is also transmitted to the tibia by way of connective tissues around the knee that make up the quadriceps retinaculum (Image 2). The quadriceps retinaculum is richly innervated, so it is likely to be a source of pain with mechanical challenges in PFPS. 2 KEY POINTS • Overactivity and excessive mechanical load are the leading causes of patellofemoral pain syndrome. • Massage can play a role in treating patellar tracking disorders, especially in reducing hypertonicity of the tissues around the patella. CLINICAL EXPLORATIONS Patellofemoral pain syndrome (PFPS) is a term that describes generalized anterior knee pain around or under the patella. Overactivity and excessive mechanical load on the patellofemoral joint are the leading causes. There isn't an apparent tissue dysfunction for the pain, but several factors may contribute to the discomfort felt during movement. Here we discuss key anatomical, biomechanical, and psychosocial factors that play a role in this challenging problem. Massage therapy treatment for PFPS is most successful when the practitioner understands the fundamentals of the joint mechanics, factors in the client's activities and lifestyle, and can blend these elements with specific assessment findings to construct a beneficial treatment strategy.