Patellofemoral pain syndrome (PFPS) is a common and frustrating condition that occurs in many people who lead active lifestyles or in people who don’t participate in enough activity. Sometimes PFPS is called “runner’s knee” as it is more common in people who participate in sports that involve running and jumping. PFPS is more common in women than men.

Pain arising from the joint between the kneecap (patella) and the thigh bone (femur) due to some form of irritation. PFPS can cause pain directly at the front of the knee or it can appear to be on the sides of the kneecap. To date, the cause of PFPS is unknown and there maybe a number of contributing factors leading to this impairment.

Some of the factors that could cause PFPS are listed below:

•   Overuse: Repetitive running or jumping puts stress on the knee joint which can cause irritation under the knee cap.
•  Muscle imbalance or weakness: Imbalance or weakness in the hip and knee muscles can cause stress on the knee structures and lead to irritation under the kneecap which will result in inflammation and pain.
•  Injury: Direct trauma to the kneecap such as a dislocation, contusion or even a fracture of the patella can later cause symptoms of PFPS.
•  Surgery: Knee surgery, especially ACL surgeries using patellar tendon as a graft can later lead to symptoms of PFPS.

There can be a number of factors that can lead to PFPS; therefore, it is crucial to have a physiotherapy assessment to get properly diagnosed and get directions for the most effective treatment.

What will my physiotherapy assessment look like?

A  detailed conversation with the physiotherapist to get specific details to help determine what is causing the pain and determine the aggravating and easing factors.

The physiotherapist will then conduct a physical exam to better understand the source of your pain and confirm the diagnosis.

The physical examination will consist of:

•   Variety of movement exams which will include walking, hip and knee mobility testing
•   Quick scan of your hip and feet to rule out dysfunction. Sometimes biomechanical dysfunction in these joints can refer pain to the knee.
•   Strength testing of your knee and hip muscles
•   Testing functional movements like squats, jumps, kneeling and climbing stairs.
•   Special knee testing to confirm diagnosis of PFPS.

A diagnosis for PFPS is often made when there is a clear involvement of the patellofemoral joint. People with PFPS will often have difficulty with hills, pain with squatting and going down the stairs.

As previously mentioned, the management will vary depending on the contributing factors, but some key treatment principles should be kept in mind.

1.  Rest – Remember that PFPS is an overuse injury so an initial period of de-loading to allow the joint to settle down is very important. This may only be for a couple of days or a week depending on the severity.

2.  Gradual re-loading – As it is an overuse injury, a graduated return to activities will help to prevent the injury from re-occurring. This is a crucial step because if you start re-loading and progress quickly it can lead to another flare up.

3.  Progressive Exercise Program – Strengthening exercises to strengthen the weak muscles and stretches to lengthen the tight muscles to address the muscle imbalance in the knee and hip joints.

4.  Pain relief – K-Taping, heat or ice all may be used to help provide some level of pain relief especially during the earlier stages of healing but also once you start gradual re-loading to manage inflammation and pain.

5.  Patience – PFPS can be a longstanding condition, patience and compliance are key for successful treatment outcomes. Remember, if PFPS is due to a muscle weakness then with gradual re-loading you will need at least 8-12 weeks for muscle hypertrophy a.k.a building muscle and improving your strength.

To learn how to best manage your knee pain and find pain relief today contact Prestige Physiotherapy to book a comprehensive physiotherapy assessment.