Patellofemoral Pain Syndrome.

Ever experienced that vague sense of pain around your kneecap that just keeps coming back when doing activity? Patellofemoral pain syndrome (more commonly referred to as PFPS) is one of the most common causes of knee pain, especially in active individuals and is typically characterized by pain around or behind the kneecap that is aggravated with sports, running, stairs or deep squatting. The good news is that PFPS is often able to be very effectively managed conservatively with a few key principles.

But what’s actually happening underneath the surface? PFPS is best understood as a load related issue rather than a structural damage issue. The patellofemoral (knee cap) joint is highly sensitive to changes in load, and when the joint is exposed to more stress than it can currently tolerate, pain develops. Risk factors for developing PFPS include sudden increases in knee loading (sports, running, jumping, stairs etc.), weak muscles (commonly quadriceps and glutes), tight muscles, foot biomechanics and other anatomical contributors.

To make it more confusing, its rarely ever one single factor that causes symptom onset – however it does usually involve a mismatch between load and capacity in some form.

Management should therefore focus on restoring that balance.

The first step is load modification. This doesn’t however, mean complete rest as this can cause a further reduction in capacity, meaning when load is reintroduced it quickly exceeds the threshold required for pain to return and you risk falling into a boom bust cycle. Instead, the aim should be to temporarily reduce or adjust aggravating activities to a level that is tolerable and this is where taping, massage and stretching can be useful. From there, progressive strengthening becomes the cornerstone of rehab, with key areas to target including the quadriceps, hip and glute to improve overall limb control and increase the joints capacity to bear load.

Consistency and progression are what drive improvement and even when done correctly, pain can linger for several months with some individuals. In other situations, pain can settle relatively quickly however may return whenever load spikes, and in these occasions it is important to continue to strengthen and build the knees capacity even after symptoms subside.

This is also an important time to point out not all knee pain is PFPS and there are certain symptoms to look out for that may indicate something more complex which requires assessment from a health care professional. Examples of more serious symptoms include:

· A significant twisting injury with immediate swelling

· Sudden onset pain at high levels.

· Locking or catching of the knee preventing full movement

· Persistent or worsening swelling

· Pain that is progressively worsening despite reducing load

· Night pain or pain at rest

· A feeling of instability or the knee “giving way.”

While PFPS can be managed well conservatively by focusing on correcting the imbalance between load and capacity, if you’ve trialled some of these measures and are yet to see any results and want a more individualised rehabilitation program or simply want to feel confident that you’re doing the right program, then booking in with one of our qualified physiotherapists is an excellent option. Our physiotherapists can conduct comprehensive subjective and objective assessments to determine if PFPS is an accurate diagnosis, as well as what factors are contributing, which can then be used to design rehabilitation programs tailored to your goals and lifestyle.