Patellofemoral Pain Syndrome

What is patellofemoral pain syndrome? with Dr. James Ebben

Patellofemoral Pain Syndrome (PFPS) is the term used to describe pain at the front of the kneecap or surrounding the kneecap area. PFPS in very common in the young and active population, athletes of all ages, people who work in physical labor intensive jobs, and tends to be more common in females. It can also occur in the older adult due to age-related changes of the cartilage beneath the kneecap.

There are three bones that make up the knee joint: the femur (thigh bone), the tibia (shin bone), and the patella (kneecap). The kneecap sits in a groove on the front of the thigh bone and it slides up and down that groove as you move. Pain occurs when there is movement of the kneecap outside of that groove causing rubbing of the bones outside of their normal track. This can cause inflammation which leads to pain and ultimately can wear down the joint surfaces if it is not addressed.

PFPS commonly occurs with overuse. The kneecap is attached to the quadriceps muscle and it glides through a groove in the end of the thigh bone. With repeated bending and straightening of the knee, the inside surface of the kneecap can become irritated if it does not move correctly in this groove. Pain can occur because of the way the hips, knees, ankles, or feet are aligned and/or how they move. Body mechanics (the way a person moves) can be due to weakness or inflexibility of the muscles around the hip and the knee.

The main symptom of PFPS is pain behind the kneecap. Sometimes pain can be felt when touching around the kneecap. Pain may occur when walking, running, or even sitting for a long period of time. The pain is generally worse when running downhill or going down stairs. The knee may swell. Runners may feel or hear snapping, popping, or grinding in the knee.

Generally, X-rays are not needed to diagnose PFPS but can be ordered to rule out other possible causes of knee pain. There are several different tests that a physical therapist can complete to diagnose a patient with PFPS including pressing on specific areas of the knee, checking strength, and assessing symptoms during different activities. 

Typical exercises for PFPS include strengthening of the hip, including the buttocks, strengthening of the quadriceps muscle or thigh muscle, ankle strengthening, as well as, abdominal focused strengthening. There are a number of flexibility exercises including the hip, knee, ankle, as well as, the lower back that can be helpful. Physical therapists will also guide a patient in the proper mechanics or proper way to move during various activities that cause pain which might be stairs, lifting, running, sports-specific movements, or any activity that causes pain. Taping and bracing can be helpful in the short term along with modalities like ultrasound or iontophoresis. Some patients may benefit from the use of orthotics (shoe inserts) to allow for better alignment of the foot and ankle to better position the knee.

All treatments are patient specific and a physical therapist can perform a comprehensive evaluation to choose the right intervention for each unique patient.

Surgery is not common for the treatment of PFPS. If a patient fails to make improvements with more conservative measures, it is possible that a patient can undergo an arthroscopic knee surgery or in more extreme cases a surgical realignment of the kneecap.

The typical patient can expect to see improvements within 4-6 weeks of physical therapy depending on the patient's medical history. Patients who have a lot of medical issues tend to heal slower than those who are overall healthy. Patients are typically given home exercises and regular completion of these exercises as instructed is very important in healing. Early intervention is important, the sooner PFPS is addressed, the quicker it will improve.

Proper body mechanics is important in preventing knee pain, especially for those who do repetitive movements in their work or sport. Keeping good strength in your hip and buttocks muscles is also very important. Again, early intervention is important, as soon as knee pain is interfering with patient daily activities, work or sport, it should be addressed to reduce the progression of the knee pain.