Patello femoral pain syndrome

Patello femoral pain syndrome irritates the kneecap area.

This page was last updated by Bernard Preston on 10th January, 2019.

By Bernard Preston

The patella is a common subject of complaint at the chiropractic coalface. The bone slides up and down in a groove in the femur as you walk; the underside is layered with the thickest hyaline cartilage in the body which acts as a sort of shock absorber.

Degenerative wear and tear, or traumatic shock, may cause a painful hole to develop in the cartilage; it used to be called chondromalacia patella but is now just known as PFPS. 

It occurs often after a fall directly on the kneecap, on the street or in the garden, for example; in sportsmen and women, it's usually associated with a weak quadriceps muscle or an improperly formed groove in the femur.

PFPS is strongly associated with a magnesium deficiency causing chronic arthritis and a condition called chondrocalcinosis.

The good news is that patello femoral pain syndrome in all its forms responds well to chiropractic management; well, having said that, a recent congress on the subject suggests that satisfactory outcomes of all forms of care is only in 40 percent of cases.


Chondrocalcinosis, as the name suggests, is the deposit of calcium crystals in the cartilage of joints; along with poor tracking of the kneecap it's a not uncommon cause of patello femoral pain syndrome.

Richette et al did a literature search on chondrocalcinosis and concluded:

  1. It presents at the coalface as an acute inflammation in synovial joints; it's sometimes called pseudo gout.  
  2. A form of chronic arthritis.

  • It's not uncommon, affecting about 10 percent of people aged 60.
  • In people younger than 60 a metabolic disorder should be considered.
  • Chronic magnesium depletion from drugs or poor diet is strongly associated with chondrocalcinosis.
  • Most of the joints in the body are synovial; meaning the bones are lined with hyaline cartilage and the space between the bones is filled with a very slippery fluid that acts as a lubricant.

    Ten percent of folk over sixty is a lot of people, and it may well be much higher in patients over 70.

    Most of the magnesium in your body is tied up with the calcium in the bones. Many drugs including those for anti hypertensives, contraceptive pills, corticosteroids, blood thinning medications and diuretics which all leach the body of minerals.

    If you are taking any of these drugs long term, then you are in the high risk group of suffering from chondrocalcinosis and chronic arthritis. Patello femoral pain syndrome is just one of many diseases affected by a magnesium deficiency.

    When severely depleted painful cramps in the muscles begin think in the first instance of magesium, but it could be another mineral.  

    Foods rich in magnesium include

    • the dark green vegetables such as spinach which contains 79mg per 100g and broccoli at 21mg; but beware because 30 percent is lost in the water used to boil them. See lower down for a link to how to grow spinach in the tiny garden.  
    • chickpeas contain 48mg per 100g, 
    • pumpkin, sesame and sunflower seeds and 
    • dried beans.

    These fresh spinach salad recipes with homemade hummus or pesto is one of my favourites; they make them more palatable, but the chickpeas and sweet basil add more magnesium too for your arthritic joints; your heart too.

    Patello femoral pain syndrome

    Patello femoral pain syndrome responds well to chiropractic care.

    • COLD HOT THERAPY is the first step in the management of all pain and swelling. Making an ice-cup is simple: fill a paper cup with water, place it in the deep freeze, and tear away a slither leaving the ice standing proud.
    Ice cup treatment
    • Mobilising the kneecap is a vital part of the management of patello femoral pain syndrome. This can cause some after-pain but it's temporary and rarely a problem. The crystals of calcium are ground down.
    • Quadriceps exercises are important. PFPS is often associated with a weak Vastus medialis or lateralis, which allows the patella to track to the side. Strengthening the weak muscle, using quad-setting exercises is vital in the long term.

    Clarke's test

    Clarke's test can be extremely painful when strongly positive; it makes the definitive diagnosis of patello femoral pain syndrome.

    Mrs P is a typical case. Only 51, she has pain stretching through her whole back, wrists, hips and knees for as long as she can remember.

    She has had operations on her wrists and knee. She presented first for treatment of her right patella some four months ago, having had moderately successful chiropractic treatment for her back and neck from a colleague who doesn't specialise in extremity conditions.

    Walking upstairs was particularly painful in her knee. The x-ray above confirmed the diagnosis: Mrs P has Patello Femoral Pain Syndrome but the underlying cause is chondrocalcinosis; calcium deposits in the cartilage

    She takes no chronic medication, nor has a history of any metabolic diseases. But she does have chronic arthritis pain throughout her body; she admits to an aversion to her greens as she calls them.

    Clarke's test is the definitive test for PFPS; it was strongly positive, particularly when the kneecap was pressed against the medial condyle.

    The chiropractic help for patello femoral pain syndrome is simple, non invasive and effective; nevertheless convincing scientific evidence of the value of any treatment, manipulative or medical, that is proven, is conspicuously absent in the literature. Strengthening of the vastus lateralis muscle was seen as an important long term part of the care.

    She responded remarkably quickly. I gave her the option of magnesium tablets, or a diet high in green leafy vegetables, especially spinach, hummus, sunflower seeds and dried beans. I'm glad she chose the latter. There are many other benefits from eating these foods, as Popeye well knew. 

    In the future she may also have to take the mineral supplement depending on how she responds to the spinach and seeds. A fish oil supplement is also in the offing. Aching all over? Think magnesium.

    Arthritis pain in knee

    Whilst kneecap pain is readily treated with chiropractic, pain emanating from within the knee is a far greater challenge to the clinician, be s/he medical or chiropractic. The cartilage lining the ends of the bones does not regenerate of itself unless unloaded; weight loss is the most effective treatment. Arthritis pain in knee; patello femoral pain syndrome is just one of the many degenerative conditions.

    Chronic arthritis

    Chronic arthritis is in part a dietary issue; patello femoral pain syndrome is just one manifestation.

    There are over 100 forms of arthritis so the term chronic arthritis is something of an anachronism. A magnesium deficiency pertains mainly to the most common form, known as osteoarthritis; it's wear and tear degeneration of the cartilage in the joints. 

    Nutrition has much to do with the disease; chronic inflammation caused by too much omega 6 oils and too little omega 3 oils is another common cause.

    Obesity is another common cause directly related to poor nutrition. You'll notice most of the folk suffering from the disability associated with arthritis in the knee and hip are, or have been obese; there certainly are exceptions that prove the rule. Absolutely avoid icings that are loaded with hydrogenated fats; like this Bettercreme sucks.

    Case file

    Remembering that case files prove nothing, they are simply what are known as anecdotes, they do provide useful and interesting information; however, beware, because it can also be very misleading.

    Ms J, a 40-year old woman had experienced what she called a 'weak knee' for some months; in her youth she had played a lot of hockey and had various injuries. One morning she woke up with severe pain, unable to straighten the joint and stairs were a nightmare. After three days she consulted me.

    The difficulty was that the examination pointed to different tissues involved. Clarke's test was certainly positive pointing to a patello femoral pain syndrome, but McMurray's was the real cause of her problem.

    Mobilising her knee immediately released the meniscus lock and she could walk relatively normally but it took over a month, and half a dozen treatments, to heal. She emailed me yesterday to say that it was almost normal. Perhaps more important she had suffered for years from chronic headaches; just two treatments released those fixation and she hasn't had one in two months.

    Magnesium links @ chondrocalcinosis

    Eggs Florentine and magnesium

    There are few easier ways to get your magnesium up for your patello femoral pain syndrome than eggs Florentine

    1. Wash a large handful of spinach, perhaps cutting out the stalks if old. Slice.
    2. Drop into a pot with just a smiggen of boiling water, and turn the heat on high. Put the lid on. 
    3. Meantime prepare a few of your favorite herbs and spices. I like a clove of garlic, a few sweet basil leaves, a slither of chili and couple slices of tomato. When the spinach is boiling hard, add your herbs.
    4. When it's boiling hard again, crack an egg onto the bed of spinach, put the lid on again, and turn off the heat after a minute; after two minutes if you are using gas or an induction cooktop stove as the heat stops immediately. 
    5. Smear a slice of toasted low GI bread generously with butter. Omit the toast if you are banting. 
    6. Using a shallow bowl pour all the contents of your pot onto the toast, including all the juices; that's where much of the magnesium is for your painful joints and night cramps. Eet smakellijk as we say in Holland. Enjoy. 
    • Banting diet rebuttal

    To find the links to those topics in bold, copy and paste them into the site search function on your left.

    Personal Health Insurance

    A few thoughts on medical insurance; the benefits and dangers on going without; are you disciplined enough to put away a sum every month? Otherwise you need Personal Health Insurance.


    Goodbye Steve, I love my AppleMac, in fact the love of my life. We won't forget you. Make a good job of upgrading Moses's tablets...

    One last question though: why did you have to dislocate the patella in the process of making the Apple the best computer in the world?

    Apple mac
    1. Bernard Preston
    2. Consulting a Chiropractor
    3. Patello femoral pain syndrome

    Did you find this page interesting? How about forwarding it to a friend, or book and food junkie. Or, better still, Face Book or Twitter it. 


    56 Groenekloof Rd,

    Hilton, KZN

    South Africa


    What's this site about?

    Bernard Preston books

    A family affair by Bernard Preston comes after the trilogy that starts with Frog in my Throat.
    Femoral nerve AP Xray from one of Bernard Preston's books.

    Bernie's choice foods

    Cooking green beans Bernard Preston passion

    Bernie's bread

    Bread machine loaf by Bernard Preston

    Bernie's garden

    green beans and granadillas Bernard Preston

    Bernie's bees

    Bees workforce in Bernard Preston's garden

    Bernie's chickens

    Chickens for free range eggs.

    Bernie's solar

    Residential solar panels at Bernard Preston's home

    Bernie's rainwater harvest

    Harvesting rainwater to a reservoir in the garden means a steady supply that is unpolluted by environmental toxins.