Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is a common condition which frequently affects adolescents and young adults. It is characterised by a gradual onset of vague pain at the front the knee (anterior knee pain), routinely under or around the knee cap. Pain is usually aggravated by activities such as climbing stairs, squatting, running, cycling or sitting for l

ong periods. Despite being a very common presentation, many people are unaware of the symptoms and management of this condition. This blog will help explain the condition and pathways of management used by physiotherapists.

What is PFPS?

The knee is one of the largest joints in the body and one of the most complex.  It is made up of the femur (thigh bone), the tibia (shin bone) and the patella (knee cap). Certain structures in the knee joint allow for smoother movement. The knee cap rests in a groove on the top of the thigh bone known as the trochlear. When you bend your knee, the knee cap slides back and forth within this groove. Cartlidge on the surface of all of these bones allow the bones to glide freely against each other with movement.

PFPS occurs when the nerves sense pain in the soft tissues or bones involved in the knee joint.

In some cases PFPS can lead to chondromalacia patella, which refers to the degeneration of the cartlidge on the underside of the knee cap. This cartlidge break down leads to inflammation and therefore pain.

CAUSE:

This condition can be caused by a variety of different factors. A sudden increase in load on the knee such as an increase in the frequency, duration or intensity of running. Incorrect training or changes in footwear or playing surface can also be contributing factors in the development of pain.

Poor tracking of the knee cap in the trochlear groove can also lead to patellofemoral pain syndrome. The knee cap is pushed to the side of the groove when the knee is bent and this can be caused by a range of factors.

Issues with lower limb alignment from the hips extending down to the ankles and also problems with muscular imbalance and weakness.

KNOWN CONTRIBUTING FACTORS:

• Hip internal rotation (hip rolling inwards)
• Valgus knees (knock knees)
• Foot posture
• Muscle tightness
• Knee cap position
• Quadriceps muscle control

SYMPTOMS:

PFPS is characterised by a gradual onset of dull aching pain in the front of the knee. This pain can be present in one or both knees. Pain is usually aggravated by activities that repeatedly bend the knee, sitting for long periods of time with the knee bent and popping or grinding sounds or sensations when climbing stairs or standing up after long periods of sitting.

INVESTIGATIONS:

X-rays and other scans are not required in the diagnosis of this condition.

MANAGEMENT:

Treatment of this condition aims to reduce pain and address relevant contributing factors.

Exercise is currently the best form of treatment for PFPS. These exercises are aimed at improving knee stiffness, strength, endurance and control. A large focus is placed on exercises to strengthen the quadriceps muscle as it is the main stabiliser of the knee cap.

Other management strategies include taping, orthotics, bracing and soft tissue massage.

Surgical intervention is very rarely required/ advised, and is only implemented when conservative management fails.

PROGNOSIS:

With specific exercises and addressing contributing factors, people are able to make a full recovery from this condition and return to playing sports and running.

Do you or your child have Patellofemoral pain syndrome? Book in for an initial assessment with our team at Total Physiocare now.

Blog written by Alice Smith