Sunday, August 1, 2010

Why "Patellofemoral Pain Syndrome" Is an Incomplete Diagnosis

This essay on out-of-control inflammation, by M.D. Mark Hyman over at Huffington Post, resonated deeply with me. In it, Hyman talks about how doctors are taught to shut off inflammation with medication. Sometimes the medication has serious side effects. What doctors aren't trained to do, he says, is "find and treat the underlying causes of inflammation in chronic disease."

Let me offer a word substitution for knee pain sufferers. Replace "inflammation" with the phrase "patellofemoral pain syndrome." Because you're basically talking about the same issue.

When my knees hurt much of the time, I was diagnosed as having "patellofemoral pain syndrome." To me, a rather naive patient still eager to learn everything I could about my condition, this seemed impressive, authoritative, definitive. Only later did I realize that the term meant very little.

"Patellofemoral pain syndrome" simply describes a bucket of symptoms. Here are some I found listed online:
* Aching pain in the knee joint, particularly at the front, around and under the patella.
* Swelling sometimes occurs after activity.
* Pain is often worst when walking up or down hills or stairs.
* A clicking or cracking sound may be present on bending the knee.
* Sitting for long periods may be uncomfortable. This is known as the theatre sign or movie-goer's knee.

It's a nice roundup, but misses a key element. What's wrong? And what's causing it to be wrong? And what can I do about it?

After finding no obvious reason for my pain, doctors were content to diagnose "patellofemoral pain syndrome" without exploring what was causing the problem and how it could be fixed. One simply said I was getting old (I was in my mid-40s at the time) and prescribed arthritis medication to combat the burning (i.e., inflammation) that plagued me in both knees.

I had to do a lot of research on my own and insist on an MRI to get a good grasp of the problem. It turned out I had damaged cartilage in both joints. So I needed to find a way to improve the health of the tissue.

It was that simple, and that complicated.

I succeeded (my knees feel normal again), through a long and patient exercise program that I developed myself. But it still irks me that doctors often look upon patients as a collection of symptoms that need to be subdued, neglecting the underlying source of pain. One thing I learned: you have to know what's wrong, and what's causing it to be wrong, to formulate a plan to make it right again. And "patellofemoral pain syndrome," by itself, is an incomplete diagnosis that ignores the "why?".

I'll end with Hyman, because his remarks below, though about inflammation, could be equally applied to a number of other medical conditions:
It you want to cool off inflammation in the body, you must find the source. Treat the fire, not the smoke. In medicine we are mostly taught to diagnose disease by symptoms, NOT by their underlying cause. Functional medicine, the emerging 21st [century] paradigm of systems medicine teaches us to treat the cause, not only the symptoms, to ask the question WHY are you sick, not only WHAT disease do you have.
What's more, for a knee pain sufferer, if the "source" happens to be damaged cartilage, that's not a death sentence. Contrary to what doctors may have you think, cartilage can be strengthened, healed, restored -- without $40,000 invasive surgery. It takes time, but it can be done.


  1. Did you ever research to see if your knee problems could be caused from an improper alignment of your hips and knees?

  2. My physical therapist checked this repeatedly. I'm about 99.9% sure my problems weren't because of this at all. Looking for misalignment is a "structuralist" approach to solving knee pain (do a search for that word on this blog and you'll find more of my thoughts on that subject). I think it's an overused paradigm.

  3. I was told i had this PATELLOFEMORAL SYNDROME but the thing is I am not a runner i was not into major sports when i was little i was just a kid. Running and jumping was my life. However, It is the clicking of the pain. Its not just "AFTER" activity its before , during and after activity for example: Last night we went grocery shopping, I was doing Just fine, Up until towards the last then my knee was starting to give me issues i was leaning up against things , leaning on the cart but still walking well limping. I was doing good. My daughter wanted to try on Swim suit tops so we went to the fitting room, Had to go up to customer service desk the walk from the Fitting room the customer service desk (not that far) I was feeling like i could of passed out my knee was throbbing. I went to my Chiropractor he checked it out and he told me he felt like there may be slight small tear on my LCL on my knee i have been dealing with this pain for 6 months. All i did was Step back not wrong not anything i just simply stepped back and I was to the ground. I have a bad knee that i broke 16 yrs ago. in a car accident. I don't believe that i have this PATELLOFEMORAL SYNDROME either that is why i am going to try and get a 2nd opinion. Hopefully i will be able to.

    Any help would be great

    1. I would just encourage you to get that second opinion, and get it from a doctor (not a chiropractor). If your knee gave way that suddenly, it should be examined thoroughly. The other thing you might want to think about is whether you're at your proper weight. If you're not, and you can get there, that will help your knees a lot. All this may not seem like a lot of help to you, but I think you really need someone to look at your bad knee in person because your history/symptoms sound complex.