Patellofemoral Pain Syndrome (PFPS) is broad term used to describe pain experienced around the kneecap (patella) or the surrounding tissues. Studies have reported that roughly a quarter of running injuries are due to PFPS, hence why it is also referred to as runner’s knee! The condition usually occurs gradually with patients reporting an increase of symptoms when loading the knee, especially in a flexed position. Activities such as squatting, prolonged sitting, going up and down stairs, jumping and running (especially hills) are all commonly reported as aggravating activities.
Symptoms:
- Dull ache experienced in the front of knee
- Pain begins gradually and slowly intensifies
- Pain during exercise that requires repetitive bending of the knee (running, jumping etc)
- Can be experienced in both knees at the same time.
- Pain after sustained sitting (movies, airplane, school etc)
- Cracking/Popping sounds in your knee when climbing stairs or getting up from chair.
Possible Causes:
Although the exact pathophysiology of PFPS is relatively unknown, there are several factors that could be contributing to the symptoms patients are experiencing.
- Overuse:
- Predominantly occurs with increased activity that puts repeated stress on the knee joint (e.g. jumping, running)
- It can also start due to a sudden change in frequency and intensity of training or activity (e.g. increasing days or distance).
- Usually this is due to a muscular strength and control dysfunction.
- Malalignment of Patella:
- Your kneecap is ideally supposed to be placed within the centre of your knee, however sometimes the patella moves and tracks more to one side, causing malalignment.
- Usually caused by muscular imbalances or weakness, causing the patella to shift.
- It can also be due to alignment issues with the ankle and hips.
- Changes in activity surface or footwear.
Treatment Options:
Exercise
There is strong evidence to support the role of targeted exercise therapy in the rehabilitation of patellofemoral pain. In the early stages, strengthening the muscles around the hip has been shown to improve pain by decreasing the load going through the knee. Furthermore, calf function is extremely important in running and jumping, therefore specific calf strengthening will be an aspect of the exercise program. Exercise will also progressively incorporate loading of the knee with an array of exercises. This will involve improving strength, power, proprioception and global kinetic chain movements. Concurrent to a strengthening program, depending on your goals, your physiotherapist will also provide a return to sport or running program to ensure you can get back to what you love doing. For runners, your physio may discuss strategies towards foot-strike pattern or increasing cadence to assist with pain during running.
Foot Orthotics
Foot orthotics are commonly utilised for many musculoskeletal conditions and there is evidence to support its inclusion as a treatment option for patients with PFPS. Current research demonstrates foot orthotics are effective in reducing pain in the short term (<6 weeks) for patients with increased foot pronation (flatter feet). Foot pronation increases rotation of the lower leg which in turn can increased knee valgus. Increased valgus may cause excessive stress at the knee and be a contributing factor for patellofemoral pain. Foot orthotics come in many different shapes and sizes and currently there is no evidence separating the benefits of custom or prefabricated orthoses for patellofemoral patients.
Taping
Another intervention that has benefit for PFPS patients is taping. McConnell taping is a commonly used technique to that aims to glide, tilt and rotate the patella with the aim of reducing stress on the patella during an aggravating movement. Current evidence supports the use of tailored patellofemoral taping to improve an individual’s pain in the short to intermediate term.
Education
Your physiotherapist will discuss strategies with you regarding modifying or avoiding activities to avoid aggravation of symptoms. For example, a client who complains of significant pain when running up hills may complete running on flat ground for a short period while completing a lower limb strengthening program. Hill running will return once the patient has increased capacity through the knee and surrounding musculature to cope with imposed demands. Load management is an important principle to adhere to during rehabilitation as it allows for certain exercise and activity to continue, without breaking down or causing significant increases in pain and symptoms. Additional education and advice will revolve around empowering the patient to maintain an active rehab process and providing individualised self-management strategies.
If you are experiencing knee pain, our experienced physios at peak will provide you with quality care to ensure you can return to your daily activities and sporting endeavours pain free!
References:
Brukner, & Khan, K. (2017). Brukner & Khan’s clinical sports medicine. Volume 1 : injuries (5th edition.). McGraw-Hill Education Australia.
Vora M, Curry E, Chipman A, Matzkin E, Li X. Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options. Orthop Rev (Pavia). 2018 Feb 20;9(4):7281. doi: 10.4081/or.2017.7281
Willy RW, Hoglund LT, Barton CJ, Bolgla LA, Scalzitti DA, Logerstedt DS, Lynch AD, Snyder-Mackler L, McDonough CM. Patellofemoral Pain. J Orthop Sports Phys Ther. 2019 Sep;49(9):CPG1-CPG95. doi: 10.2519/jospt.2019.0302.