​Managing Patellofemoral Pain | Blog

​Managing Patellofemoral Pain

  Posted: Jan 17, 2020

  Category: MD Newsletter


Answers About the Complex Syndrome Pain
 
Patellofemoral pain (PFP) is a common musculoskeletal disorder that represents nearly 17% of all knee pain presentations seen in general practice and up to 40% of knee pain presentations in specialist clinics, including clinics specializing in sports injury.  
 
The disorder, which is also known as patellofemoral pain syndrome (PFPS), or “runner’s knee,” is often characterized as anterior knee pain localized behind the patella. It may also present as peripatellar or retropatellar pain.
 
Pain classified as PFP typically occurs during and following patellofemoral joint loading activities such as running, climbing or descending stairs, squatting, kneeling, and posture during which the knees remain bent for an extended period of time. This includes sitting or kneeling. In short, the routine flexion of the knees can result in PFP. To make matters worse, the pain
can persist long after these activities have concluded, and PFP can persist chronically.
 
Patellofemoral pain is an easily misunderstood condition. Among general practitioners and the general public, PFP can be dismissed as a generalized knee pain (which can be common after
strenuous physical activity). It can also be mischaracterized as arthritis or osteoarthritis if not properly diagnosed.
 
Undiagnosed knee pain is often treated with acetaminophen, ibuprofen, or other easily accessible over-the-counter pain medications and NSAIDs. This treatment is dismissive of the root cause of the pain, and PFP is likely to present itself again, resulting in continued self-directed medication. Research shows that PFP is chronic in as many as 50% of PFP patients.
 
The exact causes of PFP are not yet fully understood, but complex factors likely lead to the development of PFP. Numerous risk factors have been proposed, including high BMI, weak extensor muscles, lower limb misalignment, extreme foot pronation, continual joint stress, and poor proprioception and balance. Even wearing inadequate footwear may be a potential
risk factor. Unfortunately, research on this subject area is limited and largely inconsistent because of the complex nature of PFP.
 
That doesn’t mean patients can’t receive help. Unlike arthritis or osteoarthritis of the knee, which do not commonly respond well to conservative treatment, the opposite is true of PFP.4
Treatment programs have been found to be successful on a case-by-case basis. This includes exercise therapy, such as hip and knee-based strength and range of motion exercises. Foot
orthoses may also be recommended for patients experiencing extreme pronation. Continued manual therapy also serves to counter the stresses placed on the knee.
 
It’s possible that with continued therapy and strength exercise, patellofemoral pain may be reduced or managed over time. Developing a monitored therapy and exercise program with the
patient is likely to produce positive results. Adherence to the program is also key.

Sources:

Crossley KM, van Middelkoop M, Callaghan MJ, Collins NJ, Rathleff MS, & Barton CJ. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). British Journal of Sports
Medicine, 2016;50(14), 844–852. doi:10.1136/bjsports-2016-096268
 
Alba-Martín P, Gallego-Izquierdo T, Plaza-Manzano G., Romero-Franco N, Núñez-Nagy S, & Pecos-Martín D. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review. Journal of Physical Therapy Science,
2015;27(7), 2387–2390. doi:10.1589/jpts.27.2387
 
Collins NJ, Barton CJ, van Middelkoop, M, Callaghan MJ, Rathleff MS, Vicenzino BT, & de Oliveira Silva D. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. British Journal of Sports Medicine, doi:10.1136/bjsports-2018-099397
 
Wang S-Y, Olson-Kellogg B, Shamliyan TA, Choi, J-Y, Ramakrishnan R, & Kane RL. Physical Therapy Interventions for Knee Pain Secondary to Osteoarthritis. Annals of Internal Medicine, 2012;157(9), 632.doi:10.7326/0003-4819-157-9-201211060-00007