Patellofemoral pain syndrome (PFPS) is a general term used to describe pain in the patellofemoral joint. It is also known as Chondromalacia Patella, anterior (front) knee pain or runners’ knee.
PFPS is a common condition of the knee and describes pain due to degeneration or abnormal changes of the cartilage under the knee cap (patella). This is often due to poor alignment of the knee cap as it slides over the lower end of the femur (thigh bone) with knee movement.
Patients often describe a gradual onset of pain, which is associated with activities such as squatting or climbing stairs.
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The cause of PFPS is commonly due to a combination of factors, such as overload/overuse of the joint or biomechanical abnormalities.
When the knee bends or straightens the quadriceps muscle pulls the knee cap over the end of the femur in a straight line. Commonly, abnormal patella tracking towards the lateral (outer) side of the femur will result in the undersurface of the patella wearing away on the femur. This can cause chronic inflammation and frequently pain.
There is generally no specific event or injury causing patella-femoral pain. Occasionally, however, it may follow an incident such as a fall onto or over-straightening (hyperextension) of the knee.
PFPS is a common condition seen by our Physiotherapy team. Whilst an accurate diagnosis is important, it is the identification of the underlying cause of the problem that is critical in helping patients recover from PFPS for the long term. Several factors can increase a person’s risk of developing patellofemoral pain. These include:
- Abnormal biomechanics of the knee or feet (knock-knee, flat feet)
- Tightness of the ITB (Iliotibial Band)- outer thigh
- Muscle weakness, especially of the muscle on the inside of the thigh (VMO) and the gluteals
- Repetitive activities involving a lot of bending of the knee while it is loaded, including stairs, walking on uneven surfaces, hills, jogging, squatting or prolonged sitting with the knee bent.
- Inappropriate footwear or training surface
- Poor training technique
Once all of the individual causal factors are identified, a personalised treatment plan can be implemented.
The primary aim of treatment is to reduce pain and any inflammation that may be present. Gradual progression of a rehabilitation program by a physiotherapist is important to correct contributing factors and ensure a return to full activity. Treatment and management options include:
- Sufficient rest from any aggravating activity or activities which place large amounts of stress through the patellofemoral joint.
- Low impact exercise, such as swimming or stationary cycling, can allow fitness to be maintained without causing further injury
- Reduce inflammation through rest, ice, physiotherapy. Anti-inflammatory medication as recommended by a doctor or pharmacist may also assist in the healing process.
- Pain free strengthening exercises, particularly of the VMO muscle
- Regular stretching of tight muscle groups, particularly ITB (muscle on the outside of the leg), hamstrings, calf and hip muscles
- Taping of the knee cap may help to alter the ‘tracking’ of the knee cap and bring it back to alignment
- Correction of any abnormalities in lower limb biomechanics through the use of arch supports and orthotics
If you stick with your treatment and rehabilitation program, the expected outcome is very good.