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Patellofemoral Pain Syndrome

Published: 18 October 2018

Patellofemoral Pain Syndrome (PFPS) is an umbrella term used for pain arising from the patellofemoral joint itself, or adjacent soft tissues (1). PFPS is a multifactorial condition requiring an individualised multi-modal approach. Common biomechanical contributions include abnormal tracking of the patella, lower extremity malalignment, decreased flexibility, and weakness of the hip abductors/external rotators, and quadriceps muscles (1). Due to the multifactorial nature of PFPS, a “one-size-fits-all” approach proves ineffective, and suggests a treatment approach addressing multiple factors is necessary to treat PFPS.

 

Subjective findings may include
  • Pain felt around the knee cap.
  • Pain with activities such as:
    • Prolonged knee flexion i.e. sitting
    • Standing from chair, running, squatting, going up or down steps.
  • Fear of movement. A recent study has shown that elevated activity-related fear was common in this population group (particularly in adolescents) and should be considered in treatment (2).

 

Objective findings may include
  • Pain with palpation around the patella borders.
  • Pain with squatting.
  • Poor hip, knee and/or ankle biomechanics during functional activities such as squatting or running (1).

 

Acute management
  • Soft tissue massage or dry needling to loosen tight structures (3).
  • Patella taping (1,3).
  • Increase chair height to reduce knee flexion or use of a foot stool.
  • Pre-fabricated orthotics to reduce foot pronation (1,3).

 

Long term management
  • Specific exercises to strengthen and correct biomechanics depending on impairments. The evidence shows that hip-focused with knee-focused exercise therapy regimen resulted in superior outcomes to isolated knee-focused exercise therapy (3,5).
  • Running re-training (6).
  • Weight loss.

 

References:

1. Crossley, K. M., van Middelkoop, M., Callaghan, M. J., Collins, N. J., Rathleff, M. S., & Barton, C. J. (2016). 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). Br J Sports Med, 50(14), 844-852.

2. Selhorst, M., Rice, W., Jackowski, M., Degenhart, T., & Coffman, S. (2018). A sequential cognitive and physical approach (SCOPA) for patellofemoral pain: a randomized controlled trial in adolescent patients. Clinical rehabilitation, 0269215518787002.

3. Barton, C. J., Lack, S., Hemmings, S., Tufail, S., & Morrissey, D. (2015). The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med, 49(14), 923-934.

4. https://www.pivotalmotion.physio/patellofemoral-pain-syndrome/

5. Nakagawa, T. H., Muniz, T. B., Baldon, R. D. M., Dias Maciel, C., de Menezes Reiff, R. B., & Serrão, F. V. (2008). The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study. Clinical rehabilitation, 22(12), 1051-1060.

6. Noehren, B., Scholz, J., & Davis, I. (2011). The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. British journal of sports medicine, 45(9), 691-696.