According to the Journal of Orthopedics and Sports Physical Therapy, patellofemoral pain syndrome (PFPS) is commonly used to describe a condition of anterior knee pain. It is frequently diagnosed in patients younger than 50 with knee complaints. The term anterior knee pain covers all of the problems related to the anterior part of the knee. Therefore, in order to successfully diagnose that the cause of pain, is in fact, PFPS, we muscle exclude all other pathologies.

How do we know it is PFPS?

Diagnosis consists of the following:

  • Presence of retropatellar (behind the knee cap) or peri-patellar (on the knee cap) pain.
  • Reproduction of above pain with squatting, stair climbing, prolonged sitting, or other functional activities loading the patellofemoral joint (joint involving the knee cap) in a flexed position, and
  • Exclusion of all other conditions that my cause anterior knee pain, including tibiofemoral pathologies.

PFPS can be split into classification subcategories of causes

1. Overuse/overload – pain primarily due to overuse/overload.

2. Muscle performance deficits – when there is lower limb muscle performance deficits in the hip and quadriceps.

3. Movement coordination deficits – caused by excessive or poorly controlled knee valgus (knee’s coming inwards) during certain movements (not necessarily due to weakness of the muscles).

4. Mobility impairments – caused by too much or too little movement of certain structures, i.e. higher than normal foot mobility and/or flexibility deficits of 1 or more of the following structures: hamstrings, quadriceps, gastrocnemius, soleus, lateral retinaculum, or iliotibial band.

Whilst these subcategories isolate the causes, the evidence shows that PFPS is probably multi-factorial, suggesting that a variety of factors can contribute to the pain felt in the anterior knee.

Risk Factors

There are three distinct subgroups which have been identified by studies

  • Adolescents– female > male; particularly those involved in basketball, soccer, and volleyball.
  • Recreational Runners
  • Military recruits

There is strong to moderate evidence that the following are not risk factors.

Age, height, weight, body mass index, body fat and Q angle (position that the knee cap sits)

How do we treat it?

PFPS can be treated through the help of a physiotherapist by employing the following:

  • Education – To be able to start treating the issue appropriately, you need to be educated on the nature of the condition, the prognosis, your expectations and the physiotherapists expectations.
  • Exercise therapy – using combined hip and knee targeted exercises.
  • Taping – by providing passive stability to the area via external support, pain can be decreased and stability in the patellofemoral joint can be increased.
  • Running Retraining – As mentioned above, the way that the lower limb moves may be causing the problem, by retraining an individuals’ running technique, we can decrease the excessive load and force that is causing the pain.

If you’re experiencing this pain or know anyone who is, don’t hesitate to speak to one of our Physiotherapists at Optimum Health Solutions. We will run you through a full assessment and talk to you about what is causing you grief and the next step towards resolving it.

1: Willy, R. W., et al. (2019). Patellofemoral Pain. Journal of Orthopaedic and Sports Physical Therapy, 49(9), CPG1-CPG95.

2: Lankhorst, N.E., et al. (2012). Risk Factors for Patellofemoral Pain Syndrome: A Systematic Review. Journal of Orthopaedic and Sports Physical Therapy, 42(2), 81-94.

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