Patellofemoral Pain (PFP)

Contributing Factors associated with PFP

INTRINSIC FACTORS

– More common in females

– 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 (i.e. often seen in people with ‘pronated’ or ‘flat’ feet)

– Decreased quadriceps, hamstring and calf flexibility

– Decreased or increased movement of the patella

– Biomechanical factors (low cadence, increased peak hip adduction and internal rotation movement)

EXTRINSIC FACTORS

– Rapid increases in frequency and intensity of activities which load the patellofemoral joints (i.e. increases in hill running, increased weekly running mileage, prolonged sitting at work)

– Specialisation in one specific sport or activity

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/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/movement 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

• Resistance 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.

• 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/movement retraining

The aforementioned gait parameters may continue to be modified, particularly in those with chronic or recurrent cases of patellofemoral pain. 

• Ongoing training load management

Training volume should be monitored and tailored for individuals to mitigate risk of re-injury due to overload.