Patellofemoral Pain Syndrome (PFPS)

Patellofemoral pain is one of the most common causes of knee pain.  Usually, when the knee is bent or straightened, the kneecap (patella) glides in a special groove on the femur called the patellofemoral groove. However, for several reasons, it may stray slightly from this path (usually towards the outer side of the knee).  This is called patellofemoral maltracking and produces abnormal stresses on the under-surface of the patella that can cause pain. If allowed to progress untreated over a long period of time, these stresses can potentially cause damage to the articular cartilage on the patella (known as chondromalacia patellae) and femur.  

Signs & Symptoms

The most common symptom of PFPS is pain at the front of the knee that comes and goes related to activity.  Often it occurs due to sudden increase in training. It typically occurs going up or downstairs, and whilst running. Pain can also result from prolonged sitting.  Sometimes there is a grinding or crunching sensation or sound under the kneecap, this is called crepitus.  Some people may even experience instability (either a sensation of insecurity or actual giving way).  

Causes

PFPS can be caused by numerous factors, which can be assessed by a physiotherapist, often it is due to a combination of these:

• Muscular tightness, most commonly of the quadriceps
• Poor hip control, causing the knee to roll inwards
• Pronated (flat) feet, causing the knee to roll inwards
• Poor running technique
• Weakness or late activation of the VMO muscle
• Excess joint loading due to weight
• Post surgically or secondary to knee trauma
• Anatomic variations (such as a small kneecap, hyperextending  knees or a shallow patellofemoral groove)
• In ballet dancers, it is often associated with forcing turnout

Diagnosis

A physiotherapist or GP can diagnose patellofemoral pain from your symptoms and examination.  X rays and other scans are not necessary, but may be used to rule out other conditions.

Physiotherapy Treatment

Initial treatment requires rest from strenuous exercise, avoiding painful activities, regular stretching and possibly anti-inflammatories.  Treatment focuses on rectifying the relevant factors for each individual patient.  

It is likely to include some of the following:

• Release of tight muscles with massage and/or dry needling
• Stretches for the calves, quadriceps, hamstrings, hip flexors and gluteals
• VMO exercises to strengthen and improve the timing of this muscle
• Taping of the patella
• Exercises for improving biomechanics, muscle control and quadriceps strength

For a printable pdf version please click here

‍