by Adam Brown
updated July 17, 2020
What is Patello-Femoral Pain Syndrome (PFPS)?
Your patella is the bone on the front of the knee commonly referred to as your “knee cap”, and your femur is the thigh bone that it sits upon. Your patella plays an important role in the normal function of your knee. It helps to transmit force applied by the powerful quadriceps muscles, provides protection for the front of your knee and reduces friction between the knee extensors and the joint below. As the name suggests, Patella-Femoral Pain Syndrome (PFPS) is pain derived from the connection between the patella and femur.
SIGNS AND SYMPTOMS
- Intermittent pain on the front of the knee that can be in the middle or on the medial/lateral sides of the patella.
- Pain when going up or down stairs, squatting/lunging
- Pain when walking down hill
- Occasionally people will notice some swelling around the front of the knee cap
- Some people report pain in the knee after sitting with it bent at 90 degrees for 30 min. or more, which is relieved when they straighten their leg.
CAUSES of PATELLAR PAIN
There are quite a few factors that can lead to PFPS and it is important to discover which of them apply to you specifically, so that treatment can be tailored to your needs. Here are a few of the pre-disposing factors.
- Bony Alignment – some patients have hips, thighs and knees, which are lined up in a way that pre-disposes them to having this problem. In extreme cases there are surgeries that can help to improve alignment to reduce symptoms or prevent patellar dislocations.
- Soft Tissue Tightness – Shortened quadriceps muscles or stiff and tight tissues on the lateral side of the patella can contribute to increased and unbalanced forces across the joint, producing pain.
- Poor Muscular Control – many people with PFPS have a hard time keeping their pelvis, hip and knee joints in a good position when performing any action in single leg stance. Even if the tissues are not short and the bones are well aligned, poor muscular control of the pelvis and leg can result in pain.
Diagnosis can be made based on the history and physical exam. Only in advanced cases that have been resistant to Physiotherapy treatment, or have included patellar dislocation would any imaging tests be required in order to determine the need for surgery.
TREATMENT for ANTERIOR KNEE PAIN
Physiotherapy is the treatment of choice for PFPS, and the care plan should address the specific factors that have led to the development of your problem. An approach that works well for one patient may have no effect on another if the treatment is not well matched to the root cause of their PFPS.
As mentioned earlier some extreme cases may require surgery to address issues with bony alignment. But these cases are rare.
Patella tracking braces can be used to help reduce symptoms while participating in sport. These are not a long-term solution, but rather a strategy for remaining active while working through the Physiotherapy program. Speak to your Physiotherapist for a brace recommendation. There are many products on the market and they are not all created equal!
Foot orthotics have been used widely with variable results. At Cornerstone we suggest the application of a special tape to the foot (for 2 days) in order to support the arch in much the same way a foot orthotic would. We suggest considering foot orthotics if this “tape test” relieves the knee symptoms when applied.
PROGNOSIS and OUTCOMES
The vast majority of patients can relieve their PFPS with a well-designed physiotherapy program. However, most also need to work some of their stretches and exercises into their regular fitness routine to prevent future recurrences.
PFPS is very common, but also can be very debilitating. It can sideline patients from playing their much-loved sports and affect their overall health when regular daily activities like stair climbing become painful. Seek out a well-informed physiotherapist to perform an assessment to discover the root cause of your PFPS and design a plan that will address these causes.
Adam Brown MClScPT
Adam is an orthopaedic physiotherapist and clinic owner. He is a highly experienced therapist focusing his practice on the treatment of complex injuries.
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