Patellofemoral Pain Syndrome (PFPS)

The patellofemoral joint which is an articulation formed between the knee cap and the grove within femur (thigh bone). PFPS is where pain arises from either this joint or the soft tissues around it, and while pain is commonly reported at the anterior portion of the knee, it can also radiate to other locations like the back of the knee.

PFPS can be caused as a result of patellar trauma or more commonly overuse and overload of the patellofemoral joint, anatomical or biomechanical abnormalities, muscular weakness, imbalance or dysfunction.

It is thought that one of the main causes of PFPS is the patellar orientation and alignment. When the patella has a different orientation, it may glide more to one side of the thigh bone and thus can cause overuse/overload (overpressure) on that part of the thigh which can result in pain, discomfort or irritation. However, more current research has shown that there is a large degree in variance of the knee cap in when compared to the opposite knee and other individuals in those who are pain free.

PFPS can also be due to knee hyperextension, lateral tibial torsion, genu valgum or varus, increased Q-angle, tightness in the iliotibial band, hamstrings or gastrocnemius. There is also some thought that altered biomechanics in and around the foot and ankle may contribute towards symptoms.

Symptoms

People typically report that a gradual onset of pain that can be felt in and around the anterior part of the knee. People will also report an increase in load (for example, a sharp increase in distance when running / running up hill) with difficulty climbing stairs or sitting for long periods with their knee bent.

Diagnosis

After listening to your history, onset of pain and what provokes your symptoms, physiotherapists will before a more physical assessment. Initially this will involve ruling out any other types of knee injury. While the diagnostic value of one specific test for PFPS is low, a battery of tests in combination with what you highlight as your pain provoking movements will provide a better understanding of your condition. Typically pain is brought on by squatting movements / flexion of the knee when in standing, rested knee extension and sitting back on heels.

What can physiotherapists do to help?

Physiotherapy can help in a number of ways, with the latest clinical guidelines for the treatment of PFPS include:

• Advise and education

• Exercise therapy (to include strength and motor control)

• A combination of both knee and hip exercises

• Combined interventions such as exercise therapy and either foot orthoses, patella taping or manual therapy.

• Foot orthoses

• Patellofemoral, knee and lumbar mobilisations not recommended in isolation.