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Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is a clinical diagnosis that encompasses multiple features, most commonly anterior knee pain, which is noted to exaggerate during physical activities that elevate the compressive forces on the patellofemoral joint, such as running, squatting, or stair climbing. Pain is often located behind or around the patella and is aggravated by loading a flexed knee joint. It is commonly known as ‘Runner's Knee.’



Patellofemoral syndrome is one of the most common knee conditions seen by clinicians. Women are affected more than twice as often as men. A past history, occupational history, and physical assessment are of utmost importance for diagnosis. Symptoms can be unilateral or bilateral.


Anatomy of the Patellofemoral Joint

The patellofemoral joint is a component of the knee joint (the other being the tibiofemoral joint). The patella is a sesamoid bone that articulates with the intercondylar groove on the anterior aspect of the distal femur. The patella is embedded in the anterior portion of the joint capsule.


Mechanics of the Patellofemoral Joint

When the knee flexes or folds, the patella comes into contact with the intercondylar groove of the femur bone, and this contact increases as the degree of flexion increases. In the extended position of the knee, the patella remains seated in the groove. If patellar movement is restricted, it affects the range of motion and may contribute to an extension lag.


Characteristics of Pain

Common characteristics include-

  • Localized to the anterior knee and around the patella

  • Insidious onset of poorly defined pain

  • Dull and aching in nature


Causes of PFPS

  • Direct trauma

  • Overuse

  • Faulty patellar tracking

  • Joint degeneration

  • Strength imbalance between the hip, knee, and/or ankle


Clinical Features

PFPS is commonly diagnosed by observing-

  • Pain in the retro-patellar region, along the patellar tendon

  • Patellar crepitus – noise from the knee during movement, which may or may not be painful

  • Swelling Weakness and atrophy of the hip and knee musculature

  • Difficulty maintaining prolonged knee folding/bending

  • Difficulty with running, squatting, climbing, walking, jumping, and sports-specific lower limb/knee movements

Management

Initial steps to treat PFPS include:

  • Reduce time spent in prolonged knee folding/bending.

  • Increase flexibility by implementing stretching exercises.


Mobility Maintenance:

  • Patellar mobilization – medial glide and medial tipping.

  • Taping can also be done.

Strength Improvement:

Exercises should focus on progression in terms of repetitions, resistance, or the form of activity. Balance, agility, and plyometric training can be introduced later, depending on the patient's progression, age, type of sports, and goals.


Open Chain Exercises:

  • Static quads/quads set

  • Straight leg raises in all three planes

  • Isometric exercises for lower limb muscles

  • Dynamic knee extension in sitting


Closed Chain Exercises:

  • Mini squats

  • Single-leg standing wall slides

  • Long step lunges

  • Step up and down in the forward and lateral directions

  • Short step walks



Conclusion

The prognosis for patellofemoral pain syndrome is generally good; however, studies indicate that around 40% of patients diagnosed with PFPS may experience continued symptoms one year after typical treatment. One study showed that nearly 85% of patients treated with a home exercise regimen self-reported successful outcome at seven years. A poor long-term prognosis may be associated with factors such as a hypermobile patella, older age, and bilateral symptoms.


To conclude, the condition has a favorable prognosis if the cause is well established with accurate assessment and a proper treatment plan, which must be followed consistently. Therapists should monitor the patient’s progress regularly and schedule follow-ups if needed.

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