Patellofemoral Pain Syndrome

In this blog, we will explore what patellofemoral pain syndrome is and discuss topics including how the injury occurs, recovery times, management strategies and exercise rehabilitation.

By Dr Shaun Quilty (Osteopath)

What is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome (PFS) is an umbrella term used for pain arising from the patellofemoral joint itself, or adjacent soft tissues. Also known as runner’s knee, the condition is one of the most common causes of anterior knee pain.

PFS is a condition that occurs when the cartilage under the kneecap becomes irritated or damaged. Patients typically present with generalised anterior knee pain around the patella that is aggravated by loading of a flexed knee in activities including running, climbing stairs, prolonged sitting and squatting.

Symptoms can be unilateral or bilateral, as well as gradual or acute. This condition can significantly impact a runner’s ability to train and compete at their desired level. PFS is considered a diagnosis of exclusion, once intraarticular or peripatellar pathologies have been ruled out.

PFS is typically seen in adolescents and young adults, especially those who participate in activities involving running and jumping.

Common Causes of Patellofemoral Pain Syndrome

Overuse/Overload – Increases in training load (e.g running further distances) or extended periods of exercise can overload the patellofemoral joint, leading to repetitive stress being placed on the patella. Usually patients will state that the pain began during a period of increased activity. 

Muscular Imbalance – Muscular imbalances or weakness in the quadriceps, hamstrings or glutes can cause an imbalance at the knee joint, resulting in abnormal tracking of the patella in the trochlear groove.

Lower Extremity Biomechanics – Dysfunction with the feet, ankles and hips can impact the body’s ability to successfully track the patella with movement, leading to patellofemoral joint pain.

Poor Running Technique – Maladaptive running techniques can increase the level of stress being placed on the patellofemoral joint, ultimately insufficiently loading the knee with each running stride.

Trauma – Direct or indirect injuries to the patella and knee structures can lead to PFS.

Recovery Times

Recovery times for PFS can vary depending on the severity of the condition. In most cases, individuals can expect to recover within 4-6 weeks with appropriate treatment and rehabilitation. However, severe cases may require surgery to correct malalignment and improve the tracking of the patella.

Management Strategies

PFS treatment is usually conservative and targeted at pain reduction, improving patellar tracking and returning to previous level of function. In the acute stages of the injury, resting the knee via activity modification is crucial to allow the knee time to heal. Patients can apply ice to the knee to help reduce inflammation and relieve pain, in conjunction with anti-inflammatory medication.

Following the acute phase, management is focused around targeting the most likely cause of PFS for the patient. Typically, this involves utilising manual therapy and rehabilitation exercises. Aiming to address muscular imbalances and to strengthen the surrounding structures of the knee, to enable proactive patella tracking.

The combination of knee and hip exercises to increase lower extremity strength, mobility and function is the most effective intervention for the management of PFS. Meanwhile, incorporating cross-training activities like swimming, biking and yoga can help individuals including runners maintain their fitness level while allowing the knee time to rest and recover.

In addition, patellar taping is a tool that can be used in conjunction with physical therapy to help alleviate symptoms of PFS, simply by assisting with the positioning of the patella within the patellofemoral knee joint. In severe cases, surgery may be required for the management of PFS, if conservative approaches are not successful.

Surgery is primarily focused around realignment of the patella, to ensure optimal tracking of the patella with movement. Commonly a lateral retinacular release is performed to target tight ligaments on the outside of the knee, to effectively allow the patella to sit properly within the trochlear groove. 

Exercise Rehabilitation 

Exercise rehabilitation is crucial in returning to activity and functional movements. Performing exercises that are aimed at strengthening the surrounding structures of the knee including the quadriceps, hamstrings and glute muscles is essential.

Simple exercises to help support the patellofemoral joint include single straight leg lifts, wall slides, squats, lunges, leg press, hamstring curls, deadlifts, hip thrusts and glute bridges. These exercises will assist with the recovery of the injury, but can also be used as a prevention tool.

In conclusion, PFS is a common condition amongst runners that can significantly impact their ability to train and compete. Runners can take steps to prevent this condition from occurring, by incorporating exercises into their training routine that aim to help strengthen the knee and improve patella tracking. With the right management strategies and exercise rehabilitation, runners can get back to doing what they love without the risk of further injury.

Contact our friendly Osteo team at MOSIC to find the ideal recovery for your knee pain. We can help you prevent or recover from your knee pain.