Patellafemoral Pain Syndrome in Gymnasts: Proper Landing Technique
Patellafemoral pain syndrome is a term used to describe the pain behind or around the kneecap (patella) resulting from problems with the patellafemoral joint due to over- use, muscle imbalances, abnormal gliding of kneecap, and alignment problems. This is one of the most com- mon causes of knee pain in athletes and represents ap- proximately 60% of gymnastic knee disorders. The knee is a major shock absorber during landing activities and peak vertical ground reaction forces could be 8-14x the gymnast’s body weight.
Patellafemoral pain syndrome causes pain under or around the kneecap, which can be on one or both legs, that is aggravated by prolonged sitting, squatting, run- ning, jumping, or walking downstairs. There are many factors that may contribute to the development of patel- lafemoral pain syndrome. Overuse, overload, along with repeated bending of the knee may increase pressure be- tween the kneecap and the thighbone, irritating the un- dersurface of the kneecap (articular cartilage), leading to its degeneration. This cartilage degeneration is also known as chondromalacia patellae. Muscle imbalances resulting from tightness or weakness of the thigh and hip muscles can also cause abnormal gliding of the kneecap, leading to inflammation and pain. Abnormal gliding of the kneecap towards the outside of the groove can lead to damage to the cartilage underneath the kneecap. Alignment problems are caused if the bones in the lower leg are abnormal, which include an increased angle be- tween the thighbone (femur) and shinbone (tibia), flat feet, and knock-knees.
One thing that will increase the angle between the thigh- bone and shin is how the gymnast lands. The picture above shows a gymnast landing in more of a knock-knee position, increasing the angle of the knee joint, thus in- creasing forces through the patellafemoral joint. The gymnast should land with knees directly over feet not allowing them to dive inward into the knock-knee posi- tion. Making sure the gymnast is aware of how they are landing is crucial. The gymnast needs to practice the proper landing technique to make it second nature along with strengthening the proper muscle groups to include the outside hip muscles.
If patellafemoral pain does occur the treatment is to control the pain by resting, taking anti-inflammatory drugs, and using ice packs. Modifying the activity level avoiding the motions that irritate or overload the kneecap can help. The gymnast can try non- impact aerobic exercises to maintain their fitness level, such as swimming which will not make the pain worse. Strengthening all the musculature of the affected lower extremity, especially the hips, may help take pressure of the kneecap along with stretch- ing tight muscles (quadriceps, iliotibial band, and hamstrings). Also when the gymnast is not in the gym evaluating their footwear, changing shoes, or wearing arch supports may improve lower extremity biomechanics by preventing excessive pronation (flattening) of foot to take pressure off the patella- femoral joint.