What is patellofemoral pain syndrome?
Patella-femoral pain syndrome (PFPS), commonly referred to as ‘runners’ knee’ is an umbrella term encompassing all pathologies that cause pain where the patella (kneecap) comes in contact with your femur (thigh bone). This articulation is what is referred to as the patellofemoral joint. The cause of PFPS varies but is primarily due to increased patellofemoral joint pressure from poor alignment of the patellar during movement of the knee. Over time this disrupts the surface behind the patellar, causing pain.
Signs you may have patellofemoral pain syndrome.
As flexing the knee increases the contact of structures in the patellofemoral joint, pain increases during weight bearing activities that flex the knee such as squatting, running and ascending and descending stairs. It may also cause pain during non-weightbearing tasks which flex the knee such as sitting cross legged or sitting in a chair with sustained knee flexion (it is also known as ‘movie-goers knee’).
Typical assessment findings:
- Inflammation around the knee
- Reduced mobility of the patella
- Tight lateral knee structures (iliotibial band and gluteals)
- Over pronation (rolling in) of the mid foot
- Weakness of the quadriceps and gluteal muscles
- Reduced strength and tightness of the calf muscles
How common is PFPS
Patellofemoral pain is the most common knee pain experienced by the general population, with up to 40% of all knee problems seen in physiotherapy clinics attributed to PFPS. In the general population the prevalence of any symptoms of PFPS annually is 23% among adults and 29% amongst adolescents (Smith et al., 2018). Additionally, females are at a greater risk than males with almost double the prevalence of males. The cause of this is due women’s wider hips, which increases the angel between the hip and knee (depicted below), this is known as Q angle and can contributes the poor alignment of the patella that often leads to symptoms
Can physiotherapy help and what will treatment look like?
There is strong evidence to support the use of physiotherapy in the treatment of patellofemoral pain (Alba-Martín et al., 2015). As the presentation of PFPS varies significantly between individuals, so too does treatment. All treatment will first reduce the pain caused by the acute response of inflammation and muscle tightness before progressing to correct the underlying cause of pain to prevent it from reoccurring. A typical management plan will include:
- Prescription and education on the use of ice, and non-medicated inflammatory cream to address acute symptoms and pain.
- Education on pathology and aggravating activities to avoid
- Manual therapy
- Prescription of taping and braces to reduce pain with daily tasks
- Referral to podiatry if significant overpronation of the midfoot is found to be contributing to the symptoms
- Exercise prescription to maintain mobility of joints and length of muscles
- Strength and functional training to strengthen the calf and quadriceps and stabilise the pelvis.
References:
Alba-Martín, P., Gallego-Izquierdo, T., Plaza-Manzano, G., Romero-Franco, N., Núñez-Nagy, S. and Pecos-Martín, D., 2015. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review. Journal of Physical Therapy Science, 27(7), pp.2387-2390.
Smith, B., Selfe, J., Thacker, D., Hendrick, P., Bateman, M., Moffatt, F., Rathleff, M., Smith, T. and Logan, P., 2018. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PLOS ONE, 13(1), p.e0190892.