Hoke,2 a physical therapist, provided a good analysis of the mechanical causes of patellofemoral joint pain: The knee extensor mechanism attenuates the shock, accepting body weight when the foot contacts the ground in running. This shock attenuation is accomplished through a smoothly controlled eccentric contraction of the knee extensors. The patel-lofemoral joint is a finely balanced system within the extensor mechanism, and multiple factors affect its alignment and function. The runner frequently experiences pain in the patellar region when this system lacks the necessary "balance of power" between medial and lateral forces. Excessive pronation of the foot also has been cited by multiple authors3,4 as a contributory factor in the development of anterior knee pain. The early peak in knee flexion after foot contact coincides with the peak in rear-foot pronation, and if the pronation of the rear foot becomes excessive, there will be adverse stress on the knee in the sagittal plane (increased flexion) and frontal plane (increased tibial rotation).
This analysis clearly demonstrates the "balance of power" in the finely balanced alignment of the knee system. Regular treatment should include needling all the extensor muscles—lateral, medial, and frontal—of the knee.
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