Intrigued, I managed to locate the study (most are behind paywalls, but luckily, this one was not). It begins with a fairly broad discussion of patellofemoral pain syndrome that won me over with these two lines:
Some practitioners who find no identifiable cause to the pain use both the term PFPS as well as the term AKP (anterior knee pain), but the terms are best reserved to describe the patient who has yet to be evaluated. If no causative explanation for the pain is found, despite a thorough investigation, the term idiopathic anterior knee pain (IAKP) seems reasonable.Yes, yes, yes! Let’s stop pretending PFPS is a real diagnosis. “Idiopathic anterior knee pain” is more honest and useful. Basically, it means “you have pain in the front of your knee and we don’t know why.”
There is another discussion section, at the report’s end, that is well worth perusing too. The researchers’ skepticism about catchall explanations for PFPS that cite mechanical abnormalities is virtually palpable.
Here are three big problems with the “oh, you’re crooked/imbalanced” line of thinking.
(1) There’s no accepted definition of what constitutes crooked in the first place -- or more precisely “meaningfully crooked” if you will, because I’m sure very small discrepancies in the length of someone's legs (or in whatever) wouldn’t be considered important even by diehard structuralists.
To make this more concrete: Say you believe patellar maltracking causes most cases of PFPS. Well, if a kneecap doesn’t track perfectly by 1/100th of a millimeter (the width of a thin hair), that’s not enough to be significant. But then, what is? 2 millimeters? 6? 10, 20? The fact is, no one has set forth an assertion on this that’s supported by clinical evidence. So we don’t even know what crooked is.
(2) Also we can’t measure it well anyway (a related, overlapping issue). The Swedish researchers report:
“Fitzgerald and McClure (1995) studied four different manual clinical tests for patellofemoral alignment where measurement reliability ranged from poor to fair ... they were unable to find a reliable clinical method for assessing alignment.”So there’s no accepted definition of malalignment and no good way of measuring it anyway. But wait, it gets worse:
(3) “Fairbank, Pynsent, van Poortvliet and Phillips (1984) reported that in pain-free subjects, between 60% and 80% of the population fall into what is generally classed as lower extremity malalignment.”
So, even when someone does take a stab at defining malalignment, it turns out -- surprise -- that most of us who are pain-free share this “problem.” In that case, if almost everyone is crooked/imbalanced, what’s so special about it?
And the answer just may be: not much at all.