There are a number of reasons why patellofemoral syndrome may occur. Some common ones include:

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• Malalignment of the knee cap
• Overuse
• Kneecap instability
• Direct trauma to the knee
• Tightness, weakness or imbalance of the patella and/or thigh muscle
• Flat feet
• Hypermobility

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Common symptoms related to patellofemoral syndrome are:

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• Pain under or around the kneecap
• Pain while walking up and down stairs, or after sitting, squatting or kneeling with a bent knee for a long period of time
• Grating or grinding sensation while bending the knee

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To determine if your child has patellofemoral syndrome, our specialists will perform a physical exam that may include flexibility tests, stress tests, muscle tests and gait analysis. These tests will help our specialized team better understand your child’s condition, assess range of motion and identify abnormalities that might occur in bone alignment or muscle function.

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After a physical exam, our specialists may also order imaging tests such as an X-ray, MRI, ultrasound or computed tomography.

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Possible non-surgical treatments your doctor may offer or recommend to treat your child’s patellofemoral syndrome include:

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• Rest and activity modification
• Physical therapy and home exercise programs
• Bracing
• Over the counter non-steroidal anti-inflammatory drug (NSAIDs)

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At-Home Care

Common at-home treatment options for patellofemoral syndrome include:

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• Icing the Area: Put ice packs wrapped in a towel or thin cloth on your child’s knee for 20–30 minutes every 3-4 hours for the first 2-3 days. If pain does not go away, contact your healthcare provider.

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• Elevating the Injured Limb: Elevate your child’s lower leg by placing it on a pillow when your child is lying down. Elevating it above the heart level can help reduce swelling and pain.

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• Taking Non-Prescription Medication: Take a non-steroidal, anti-inflammatory drug (NSAID), such as ibuprofen as recommended by your healthcare provider.

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• Exercising: Your doctor may recommend doing exercises at home. These are designed to stretch the affected knee, maintain range of motion in the joint and strengthen your child’s knee.

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• Stretch the knee before and after exercise
• Increase training gradually
• Use proper running gear
• Make sure that shoes fit properly and provide good support
• Use proper running form
• Perform exercises to strengthening the thigh, hip and trunk muscles
• Perform warm up and cool down stretches, especially the thigh muscles
• Avoid playing or practicing on hard surfaces, like concrete
• Avoid single sport specialization
• Avoid playing on multiple teams in one season
• Do not participate in sports more hours per week than your child’s age
• Take on season off each ear for fun free play

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Below are common exercises a doctor may recommend to help your child recover after patellofemoral syndrome. Always check with your doctor to find out which exercises are right for your child.

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Stretching

Hamstring Stretch

• Lie on back and bring the affected leg towards the chest.
• Grab the back of the thigh and try to extend the leg.
• Your child may also try this with a towel around the foot if it is more comfortable.
• Hold for 30-60 seconds. Repeat 3 times.

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Standing Calf Stretch

• Facing a wall, put hands against the wall at about eye level.
• Keep the uninjured leg forward and the injured leg back about 12-18 inches.
• Keep the injured leg straight and the heel on the floor.
• Keep toes pointed towards the wall.
• Next, do a slight lunge by bending the knee of the forward leg. Tell your child to lean into the wall until they feel a stretch in the calf muscle.
• Hold for 30-60 seconds. Repeat 3 times.

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Quadriceps Stretch

• Stand sideways to a wall, about an arm’s length away from the wall, with your injured leg towards the outside.
• Facing straight ahead, keep the hand nearest the wall against the wall for support.
• With your other hand, grasp the ankle of your injured leg and pull your heel up toward your buttocks. Do not arch or twist your back.
• Hold this position for 30 seconds.
• Repeat three times.
• Note: This may also be done while lying on the opposite side and grasping the ankle of the affected leg. Do not arch or twist your back. Hold this position for 30 seconds. Repeat three times.

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Strengthening

Straight Leg Raise

• Sit on the floor with the injured leg straight and the other leg bent, foot on the floor.
• Pull the toes of the injured leg in as far as possible, while pressing the back of the knee down and tightening the muscles on the top of the thigh.
• Raise the leg six to eight inches off the floor and hold for 5 seconds.
• Slowly lower back to the floor.
• Complete 3 sets of 10.

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Prone Hip Extension

• Lie on stomach.
• Squeeze buttocks together and raise injured leg 5-8 inches off the floor.
• Keep back straight and the hip of the lifted leg on the floor. Hold leg up for 5 seconds, then lower it. Do not let hip roll open while lifting the leg.
• Repeat 10 times. Do 3 sets of 10.

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