Knee pain is one of the common conditions that are prevalent in the general population. Patellofemoral pain syndrome (PFPS) is one of the commonly diagnosed knee conditions. Patellofemoral pain syndrome, also known by its name Anterior knee pain or Runner’s knee. It approximately affects 23% in adults, 29% in adolescents and is known to be more frequent in women (Yanez-Álvarez et al. 2020) and athletes. Patellofemoral pain (PFP) is prevalent in adults under the age of 40. The long-term prognosis is poor for Patellofemoral Pain syndrome . Estimated only one-third of patients are pain-free in one year, and 91% still report pain and dysfunction four years after onset. (Benjamin E. Smith et al. 2019)
Patellofemoral pain is a diffuse pain in front of the knee or below the kneecap, usually unrelated to any trauma or no known specific cause.
Diagnosis is usually done based on the clinical history and requires ruling out any injury to ligaments or menisci in the knee. Patellofemoral pain syndrome is often a multifactorial problem.
Pain in and around the knee and behind the kneecap with weak knee muscles usually causes reduced function in the knee, impacting daily activities, quality of life and sports.
Symptoms commonly associated with patellofemoral pain syndrome include:
The most common feature of PFPS is a pain in or around the anterior knee that increases when the knee flexion occurs during loading activities.
Swelling in the knee
Knee clicking or grinding
Pain increasing with activities like prolonged sitting, walking downhill, walking downstairs, squatting, kneeling, hiking etc.
Pain is usually relieved by stopping the activities
Potential causes of Patellofemoral Pain Syndrome:
Muscle insufficiency: Muscles are unable to provide or exert a normal force for a typical movement pattern to occur. There is associated cramping sensation as the muscles are unable to shorten or lengthen to allow full joint movement. Muscle insufficiency usually is caused by a combination of weak or tight muscles.
Overuse Syndrome: Performing repeated activities and sports that require repeated bending of the knees like repeated squatting, jumping, causing an increased risk for PFPS.
A sudden increase in activity level without proper training (running) can cause an increased load to the knee that is more than usual, leading to anterior knee pain.
Wearing inappropriate footwear during training/ exercises can also lead to knee problems.
Direct trauma to the kneecap during sports-related activities or fall can lead to PFP.
Associated Factors for Patellofemoral Pain Syndrome:
Many patients with Patellofemoral Pain syndrome develop associated pain such as fear-avoidance, catastrophizing thoughts, and low self-efficacy. These factors affect the function and quality of life of patients and alter their individual pain experience, which often leads to a chronic pain state. A systematic review found self-efficacy and depression were among the most substantial prognostic factors for pain and disability regardless of the intervention used (Benjamin E. Smith et al. 2019). Based on this foundation, the interventions aimed at improving pain-related fear and movement through education and gradually increasing physical activity with self-management strategies.
How can you help your knee pain?
- Avoid prolonged resting or inactivity. Perform activity as tolerated during the day like short walks, cycle, swim etc.
- Temporarily avoid deep squats and kneeling.
- Temporarily restrict running and prolonged walking and reduce the intensity to activity as tolerated.
- Avoid prolonged sitting with the knee in the bent position; instead, try moving the knee several times, bend and straighten knee 5-10 times every 15 minutes while you are sitting.
- Wear appropriate footwear. Avoid wearing high heels, sandals and shoes that lack adequate foot support.
- Avoid strenuous knee extension exercises during gym training.
- Regularly perform warm-up and stretch before and after any activity or exercises.
Treatment for Patellofemoral pain Syndrome:
With the knowledge that PFPS is multifactorial, it is all-important to recognize that every patient with PFPS is distinctive and will require an individualized treatment approach.
Multi-modal nonoperative therapy with short-term use of NSAIDs, taping and bracing to the knee. Exercise therapy to include knee strengthening, core training, hip and trunk muscle training has shown to be the best course of treatment to manage Patellofemoral Pain syndrome.
Injections remain a commonly used treatment for knee pain; however, the evidence for their use in patellofemoral pain is still limited.
Surgical Interventions are typically not performed due to a wide range of effective conservative treatments available for PFPS. Most surgical interventions aims at treating malalignment or injured cartilage. Surgical consultation for PFPS is usually considered for those patients whose symptoms persist past 6-12 months of conservative management of home exercises and active rehabilitation and in the case of severe instability in the knee.
Exercise therapy is an evidenced-based conservative approach often prescribed for PFP. There is strong evidence that supports strength training as part of exercise programmes for conventional treatment, to obtain better results in terms of pain reduction and for improved function.
A loaded self-managed exercise programme designed around pain education and self-management strategies is feasible and is all acceptable for PFP (Benjamin E. Smith et al., 2019)
How can a Physiotherapist Help?
Our Physiotherapist will perform assessment and provide treatment based on the findings and will often include pain education, manual therapy, mobilization, taping of your knee. Also, providing physiotherapy based exercises to retrain your muscles, improve flexibility and muscle strength in your lower extremity. As the pain reduces, the workouts are usually progressed and challenged based on your activity level and needs. You may also be recommended for a brace or to see an orthotist for consultation if required.
Please consult your physiotherapist if you are experiencing knee pain.