What Is Patellofemoral Pain Syndrome & How Do I Manage It?

Patellofemoral pain syndrome (PFPS) is the most common cause of anterior knee pain¹. The pain is usually located at the front of the knee joint, around and/or behind the patella, also referred to as the kneecap. Pain usually occurs when tension is put on the extensor mechanism of the knee during loading of the lower extremities, such as while walking, running, jumping, stair climbing, and prolonged sitting and kneeling². The patellofemoral joint consists of the patella and trochlea of the femur. The trajectory of the patella within this groove is called patellar tracking. As the knee bends, the patella comes into contact with the trochlea. Patellar mal-tracking is often a result of an imbalance and/or dysfunction of the musculature surrounding the knee and hip joints, as well as dynamic control of the core stabilizers³. This causes the patella to rub against the underlying bone, causing inflammation and pain. 

Modifiable Risk Factors for Patellofemoral Pain Syndrome

The etiology of this condition is multi-factorial. Here are several examples of modifiable risk factors that may predispose you to the development of patellofemoral pain syndrome, including:

  • Recent training volume increase/overtraining²
  • Decreased knee extension strength⁴ ⁵ and hamstring strength⁵
  • Abnormal vastus medialis obliquus/vastus lateralis reflex timing⁵
  • Decreased flexibility of the quadriceps, hamstrings, gastrocnemius or iliotibial band⁵
  • Decreased strength/recruitment of hip muscles (i.e. gluteus maximus, gluteus medius, etc.)⁵
  • Patellar compression or tilting⁵
  • Generalized ligamentous laxity⁵
  • Foot overpronation⁶

Manage Your Patellofemoral Pain Syndrome Right Now!

Rest: Depending on the severity of this condition, rest can vary from simply refraining from physical activity and sports, to using crutches temporarily to reduce the amount of weight on the injured knee. There is no golden rule concerning how long to rest. Before you can return to any form of exercise, there should be no pain with daily activities (walking, going up/down stairs, etc.).

Medications: Please consult your doctor to inquire about any medications you can take to help relieve your knee pain.

Cold packs/ice: Place a cold pack on the front of your knee for 15-20 minutes at a time, every 2 hours, or as needed. The cold pack will help relieve your pain and reduce any inflammation caused by the injury. Avoid heat within the first 48 hours after injury.

Proper posture: Avoid kneeling and cross-legged positions, as they will likely aggravate your injury. When the knee is bent, the patella is in contact with the trochlea of the femur, increasing compression at the patellofemoral joint. Therefore, prolonged sitting may also aggravate your knee pain.

Optimize strength and flexibility: Sufficient dynamic control and strength of the quadriceps muscles (i.e. vastus medialis obliquus), the hip muscles (i.e. gluteus maximus and gluteus medius muscles) and the deep core stabilizers (i.e. transversus abdominis and multifidus muscles), as well as optimal flexibility (i.e. quadriceps muscles and the iliotibial band) are crucial for the prevention and management of patellofemoral pain syndrome.

Consult your physiotherapist: A physiotherapist will perform a comprehensive evaluation to determine the cause of your patellafemoral pain syndrome. Afterward, they will treat your patellafemoral pain syndrome through the use of a variety of techniques such as manual therapy, myofascial release, taping, etc. In addition, they will provide you with a home exercise program detailing the exercises necessary to optimize your strength and flexibility to help manage your injury and to prevent it from recurring.

Written by:
Anthony Teoli MScPT
Registered Physiotherapist

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If you have any questions or concerns regarding your knee pain, please consult your doctor and/or physiotherapist. If you have any questions or concerns regarding the content of this blog post, you may contact me directly at infophysiotherapy10@gmail.com.

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DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. This blog was not created to provide physiotherapy consultations, nor was it created to obtain new clients. I am adamant on patient education and it is an absolute privilege to share my knowledge. The information contained on this blog is a resource for information.  This blog was created to inform the general population about different musculoskeletal, neurological and cardiorespiratory conditions in a variety of patient populations. For any further questions or concerns regarding patellofemoral pain syndrome, please consult your doctor or physiotherapist.

References

1. Dixit, S., Di Fiori, J. P., Burton, M., Mines, B. (2007). Management of Patellofemoral Pain Syndrome. Am Fam Physician, 75(2), 194-202.

2. van der Heijden, R. A., Lankhorst, N. E., van Linschoten, R., Bierma-Zeinstra, S. M. A., & van Middelkoop, M. (2015). Exercise for treating of patellofemoral pain syndrome (Review). Cochrane Database of Systematic Review, Issue 1.

3. Davis, I. S., & Powers, C. (2010).Patellofemoral Pain Syndrome: Proximal, Distal and Local Factors. Journal of Orthopedic and Sports Physical Therapy,40(3), A1-A16.

4. Lankhorst, N. E., Bierma-Zeinstra, S. M. A., & van Middelkoop, M. (2012). Risk Factors for Patellofemoral Pain Syndrome: A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy, 42(2): 81-A12.

5. Waryasz, G. R., & McDermott, A. Y. (2008). Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dynamic Medicine, 7(9): 1-14.

6. Collado, H., & Fredericson, M. (2010). Patellafemoral pain syndrome. Clin Sports Med, 29(3): 379-398.

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