Patellofemoral Pain Syndrome Physical Therapy Treatment
Patellofemoral pain syndrome (PFPS) is one of the most common types of knee pain, causing pain at the front of the knee and under and around the kneecap. Known as runner’s knee, PFPS is common in athletes following a sudden increase and intensity in training and affects women more than men. Physical therapists treat PFPS with a customized exercise rehabilitation program, targeting specific muscles of the hip and knee with strengthening and coordination exercises to reduce pain and retrain hip and knee movement patterns.
Anatomy of the Patellofemoral Joint
The patellofemoral joint consists of the patella (the kneecap) and the femur and is important for knee extension and deceleration. The patella works as a lever within the leg, decreasing the amount of force that the quadriceps must exert to extend the leg at the knee. The patellofemoral joint is stabilized by the quadriceps, the patellar tendon, and a series of ligaments.
When the patella is functioning correctly, the kneecap slides smoothly on the femur in a groove during movement. However, pain occurs when friction is created between the femur and the undersurface of the kneecap and the kneecap fails to track properly, leading to tenderness in the kneecap and sensitivity in the ligaments surrounding the kneecap.
What is Patellofemoral Pain Syndrome (PFPS)?
Patellofemoral pain syndrome (PFPS) is a common knee condition that causes pain at the front of the knee, under, and around the kneecap, accounting for 25% of reported knee pain. It often affects runners, cyclists, athletes, office workers, and those who sit for long periods of time. It is also common in athletes who have suddenly increased the intensity of their workouts or are performing activities with improper form.
Further factors that contribute to PFPS include weakness of the thigh muscles, particularly the quadriceps, that control patella movement and stabilize and align the leg; specialization in a single sport that requires repetitive movements; hip and knee movement patterns while running and jumping; activities such as running, squatting, and going up and down stairs; and the female sex. Women are twice as likely to experience PFPS than men due to the anatomical structure of women’s legs.
Symptoms of PFPS include:
Pain in and around kneecap when engaging in weight-bearing activities (running, jumping, squatting, or going up or down stairs)
Pain that worsens with prolonged sitting or descending stairs or intense pain when squatting
None or very little swelling
May develop slowly due to overuse or due to an acute traumatic incident to the knee
Physical Therapy Treatment for Patellofemoral Pain Syndrome
Physical therapy can address and treat patellofemoral pain through a customized exercise rehabilitation program. The physical therapist initially performs a series of tests to evaluate the knee, analyzing movements that cause pain and the patient’s gait and running patterns as well as testing the strength of the hip and thigh muscles.
Studies have shown that exercise therapy improves short-and long-term pain both at rest and during activity in patients compared to those who did not engage in exercise therapy. Exercise therapy is the critical component of physical therapy treatment for PFPS and all other interventions should be done in combination with exercise therapy to reduce pain and support return to normal function. Patients generally return to sport and activity within four-to-six weeks, increasing their activity gradually as symptoms decrease.
Physical therapy treatment for PFPS involves:
Exercise therapy: targeted strengthening exercises for the hip muscles, quadriceps, and knee muscles and ligaments to reduce pain and improve functional performance. Treatment begins with non-weight bearing exercise and progressively advances to weight-bearing exercises.
Movement pattern and gait training: in order to address any compensatory movement patterns that aggravate knee pain and provide retraining for proper biomechanics when walking and running.
Coordination training: retraining of the hip and knee movement patterns, particularly when climbing stairs, squatting, running, and jumping.
Core strengthening exercises: strengthen trunk muscles to support overall body movement and take pressure off of the patellofemoral joint.
Manual therapy: used to alleviate pain, involving joint mobilization to stretch tight ligaments and muscles around the kneecap and thigh in order to improve mobility and allow for proper kneecap alignment.
Kinesiotaping: used for short-term pain relief and temporarily support proper alignment of the kneecap during movement.
Foot orthotics: if abnormalities of the foot are contributing to patellofemoral pain, foot orthotics can support proper leg and kneecap alignment and correct gait.
Patient education on load management, cross-training, running form, and progression of training exercises to avoid overloading the knee too quickly
Patellofemoral pain syndrome can limit your daily activities and your ability to fully engage in your sport. Don’t wait to treat PFPS. Work with your physical therapist early on to address your pain and return you to your activities with improved strength and mobility!
