This is a condition which is very close to home as I have experienced this for a large part of the last 3 years! I am very passionate about helping other people manage and treat this painful condition. I hope you find this blog informative (whether you have knee pain or not) and can take away some useful tips.
What is Patellofemoral Pain Syndrome (PFPS)?
The patellofemoral joint is the joint between your patella (kneecap) and femur (the large bone in your thigh). Patellofemoral pain syndrome (PFPS) is an umbrella term used for pain arising from the patellofemoral joint itself or the nearby soft tissues (muscles and ligaments). PFPS is one of the most common knee complaints and is most common in young and active individuals aged 18-35, particularly females.
How do I know if I have PFPS?
PFPS often causes pain at the front of the knee but can occasionally also cause pain at the back of the knee. It is aggravated by activities that increase compression forces at the patellofemoral joint such as ascending/ descending stairs, sitting with your knees bent, kneeling and squatting.
What causes PFPS?
PFPS can be due to injury to the patella, but is more often from a combination of several factors, including:
- Overuse and overload of the patellofemoral joint – eg with jumping, squatting or running
- Anatomical and biomechanical (movement) abnormalities
- Muscle weakness, imbalance or dysfunction
One of the main causes of PFPS is the alignment of the patella. When the patella has a different orientation to ‘normal,’ it may glide more to one side of the femur and cause overuse or overload on that part of the femur. This can result in pain, discomfort or irritation.
Sometimes the pain and discomfort is localized in the knee, but the source of the problem is elsewhere. For example, foot pronation (a foot that rolls in) changes the mechanics of the knee and can lead to PFPS. Hip movement can also influence the knee and provoke PFPS. As I sometimes like to say to my patients, the knee is often the ‘middle-man’ or ‘the meat in the sandwich’ and is often being affected by the joints or structures above and below (the hip and the ankle/foot).
What to do about it?
There are a number of strategies that can help in the management of PFPS:
- First of all, see a professional (such as an osteopath) who can assess your knee and make a diagnosis. There are other conditions which can masquerade or present in a similar way to PFPS (such as patellar tendinopathy – more on this later), so it is important to get the correct diagnosis in order to determine an appropriate treatment plan. Your osteopath will also aim to determine what are the primary contributing factors to your pain, eg muscle weakness/tightness or poor mechanics.
- Relative rest (or ‘load management’) – this means resting from or reducing aggravating activities, such as squatting, jumping or running. Your therapist should assess your movement patterns and technique with these activities (and even things as simple as getting I and out of a chair) in order to identify any movements that may be contributing to your pain and how to modify them to make them less painful.
- Cold therapy/ anti-inflammatories – this can be helpful in the short term to manage your pain. Using an ice pack on the front of the knee for up to 15 minutes at a time, multiple times can reduce pain and any swelling that may be present. Be sure to allow the skin to return to normal temperature before re-applying the ice pack. Other the counter anti-inflammatories such as Nurofen or Voltaren can also be used for short-term pain management.
- Taping – taping the patella (kneecap) into more optimal alignment can provide some pain relief, particularly during activity. Your osteopath can show you how to do this.
- Manual therapy – techniques such as dry needling and massage may assist in management of PFPS by reducing muscle tightness that is contributing to the problem. Eg tightness of the quadriceps, hamstring (thigh) or calf muscles.
- EXERCISE – this is in capitals because it is a VERY important intervention in managing PFPS! Your osteopath will assess you to determine which muscles are tight and/ or weak and will develop a suitable exercise rehab program for you with the aim of helping you return to your sport or activity. They may focus on strengthening muscles such as the glutes (hips), quadriceps (thigh) and/or calf muscles.
- Orthoses/ footwear – patients with PFPS may benefit from the use of foot orthoses if they have excessively pronated (rolled in) feet and/or their knees move inwards during weight-bearing activities.
Do I need imaging?
Your therapist will recommend imaging if they think it will change the management of your complaint, or if they need to clarify the diagnosis of your knee pain. Otherwise, if the pain is improving with treatment and exercises, imaging is unlikely to be required.
Do I need to see a specialist/ surgeon?
Surgery is not recommended unless there is a history of recurrent patella dislocation (where the kneecap ‘pops out’), your knee pain is not improving with conservative treatment (see above) OR there is a history of a blow to the knee and suspected fracture.
When can I return to sport/ activity?
You can make a gradual return to activity as your knee pain improves. There should also ideally be improvements in your mechanics (movement patterns), muscle strength and flexibility before you return to activity. Your osteopath can advise you on expected timeframes for return to activity, however often it is possible to simply reduce the amount of exercise you are doing in order to manage the symptoms, rather than stopping activity altogether. Activity levels can then be gradually increased as tolerated, providing you are not continually flaring up your pain.
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