Patellofemoral Pain (PFP)
What is it?
Patellofemoral pain is a condition characterised by pain in the front of the knee, typically around or behind the knee cap. It is also commonly referred to as ‘patellofemoral pain syndrome’, ‘runner’s knee’ or ‘anterior knee pain’. Patellofemoral pain is the result of sensitisation and irritation of tissues within and around the joint between knee cap and the thigh bone.
Interestingly, researchers aren’t entirely sure which tissues are involved in patellofemoral pain, as MRI findings of ‘wear and tear’ within the patellofemoral joint do not correlate well with the development of symptoms. As such, the diagnosis of patellofemoral pain is made through the presence of a cluster of signs and symptoms.
Symptoms commonly associated with PFP
- Pain at the front of your knee with activities such as squatting, ascending or descending stairs, running and prolonged sitting
- Pain is commonly described as a diffuse, dull aching sensation
- Swelling may be present
- Joint “clicking” may be experienced
- Symptoms typically develop slowly over time; however, may also occur after an acute injury or after knee surgery
Contributing Factors associated with PFP
MODIFIABLE FACTORS
– Decreased quadriceps strength
– Decreased hip strength (abduction, extension & external rotation)
– Decreased hip control, particularly internal rotation and adduction of the hip during running or jumping tasks
– Increased tibial internal rotation coupled with rearfoot eversion
– Decreased quadriceps, hamstring and calf flexibility
– Decreased or increased movement of the patella
– Running technique
– Rapid increases in patellofemoral joint loading ie. increased running volume
– Specialisation in one specific sport or activity
NON-MODIFIABLE FACTORS
– Gender (more common in females)
– Anatomical variants ie. patella sitting laterally (patella alta), pes planus (flat feet)
– Age
Considerations in the management of PFP
SHORT TERM
KNEE TAPING
Taping may be utilised to provide short term pain relief during aggravating activities such as running or sport.
FOOT ORTHOSES
Individuals with excessive foot pronation may be prescribed foot orthoses for pain relief. There is evidence suggesting that prefabricated orthoses are sufficient to improve pain and function.
SOFT TISSUE TECHNIQUES (MASSAGE) & DRY NEEDLING
These modalities can assist with soreness and discomfort in surrounding tissues.
LOAD MANAGEMENT
A reduction in running loads which apply additional compressive loads to the patellofemoral joint are beneficial in providing a window of opportunity for tissues to recover and desensitise. In particular, reductions in hill running, weekly mileage and/or speed sessions may need to occur.
GAIT RETRAINING
If there are indications that you may be increasing patellofemoral compressive loads as a result of your running technique, gait retraining may be beneficial. This is dependent on the outcome of a technique analysis. Gait retraining may involve increasing cadence and reducing peak hip adduction and internal rotation during stance.
ANTI-INFLAMMATORY MEDICATION
Anti-inflammatories can aid recovery and settle the inflammatory process. Always consult your GP or pharmacist before taking any medication.
LONG TERM
STRENGTH TRAINING
Strength training should be conducted to improve long term outcomes. In particular, quadriceps and gluteals should be targeted. In early stages of rehabilitation, preference may be given to hip dominant exercises to avoid aggravation of symptoms.
More often than not, a gym environment will be required to ensure tissues are adequately loaded to result in gains.
MOBILITY EXERCISES
Mobility and muscle length deficits which contribute to symptoms may be targeted with exercises, including in the hip, gluteal, ankle and quadricep.
GAIT RETRAINING
The aforementioned gait parameters may continue to be modified, particularly in those with chronic or recurrent cases of patellofemoral pain.
ONGOING LOAD MANAGEMENT
Training volume (inclusive of duration, frequency, intensity, terrain etc.) should be monitored and tailored for individuals to mitigate risk of re-injury due to overload.
SUMMARY
Patellofemoral pain is manageable with appropriate physiotherapy care. For a good outcome, a tailored treatment approach is required to target an individual’s specific deficits and contributing factors.
If you have any questions about PFP pain that you may be experiencing please don’t hesitate to call or book a physio appointment online.
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