Do you have pain while running or jumping or going down stairs? Any time you sit or bend your knee, do you have pain? Is it around the kneecap or patella? You may have Patellofemoral Pain Syndrome (PFPS). Other names used to describe this condition are retropatellar pain syndrome, anterior knee pain and lateral facet compression syndrome.
What are Symptoms of PFPS?
Often people have complained of dull aches in and around the knee cap that increase with activity. Most times, patients lack swelling and don't report a trauma or moment when the symptoms started or worsened. This condition can develop after a trauma or surgery, but it is not necessary to develop problems in one or both of your knees. If it is following a trauma, a patient may describe cracking or note episodes of giving way which may be resulting from static structures like ligamentous (i.e. ACL tear or cartilage being damaged (meniscus or osteoarthritis).
A diagnosis of PFPS is done based on a patient’s description of the present problem and based on the history. This includes a change in activity or type of exercises. In runners, it may be increases in mileage for a 5k, starting speed work or plyometric training. Perhaps it’s a period of rest after being sick or just stopping training or a resumption to past mileage without a ramping up or going from track work to road work with surface changes. Other changes include changes in footwear and entering the summer and wearing less supportive shoes. A test that is used by physical therapists is a Clarke’s Test, which has low reliability with many patients, so it should be used as part of an evaluation but not the sole indicator of PFPS.
After the history, a standard strength and range of motion assessment of the lower extremities is a key component. For runners and athletes, slight deficits can contribute to "bigger" problems, so having a knee pain expert is especially important in the rehabilitation process.
In addition, we perform certain movement evaluations which include a walking and running assessment, bodyweight squat, unilateral movements like a pistol or forward reach and managing steps.
In chronic cases that have tried to manage the condition conservatively, imaging may be done if a patient's condition does not improve in 6-8 weeks. This includes x rays and possibly an MRI to make sure no significant damage is found in the ligaments, cartilage or bone. In chronic cases, it can take 1-2 years before surgery should be considered.
What Type of Conservative Treatment is Expected to Help PFPS?
In the early stages, treatment includes a combination of anti-inflammatory medications, modified rest, assessing possible risk factors, and most importantly, a combination of stretching and strengthening exercises for the lower extremity, especially at the hip and knee areas. The use of orthotics, patella taping using McConnell and Kinesiotaping techniques or patella tracking braces can help when the patient is acutely painful. Another option for a subset of patients with PFPS is soft non-customized orthoses that can help in relieving pain.
What if my Knee Pain Doesn’t Improve?
If the individual’s condition doesn’t improve, imaging is done at 6-8 weeks after starting physical therapy. In some cases, pain can be referred from the hip, sacroiliac joint or lumbar spine, so clinicians should recheck these areas for possible involvement by doing a clinical screen or imaging of the lumbar and hip region. Other conditions that can refer and mimic PFPS to the region are:
Current Treatment Options
The most common approaches for PFPS include a combination of the following:
These are treatment options that have demonstrated varying levels of effectiveness in managing PFPS with the strongest evidence being for combined knee and hip strengthening as the most effective for long term success.