Patello-Femoral Pain Syndrome

The kneecap, or patella, can be a source of significant pain when it fails to function properly. The patella articulates with a shallow groove on the femur, giving rise to the term ‘patello-femoral pain’ when irritation occurs because of abnormal movement of the joint. Whilst it is sometimes called a ‘runner’s knee’ because it occurs commonly in the physically active, patello-femoral pain syndrome (PFPS) can occur at any age and for a variety of reasons. Poor alignment of the patella or leg generally, overuse, muscular weakness or imbalances, and degenerative processes are common causes of PFPS. Physios see and treat patello-femoral pain in children, teenagers, adults and the elderly alike, though the underlying cause of the problem may vary with each. In statistical terms, patello-femoral pain may account for up to 10% of all visits to a sports injury clinic, with as much as 7% of all young active adults affected. That tells us it is very common, and fortunately it also usually responds very well to Physiotherapy treatment.

Characteristics of Patello-Femoral Pain

• Pain in the front of the knee, behind and around the kneecap, often perceived as an ache deep within the knee that becomes sharper with activity. Swelling around the margins of the kneecap may accompany the pain.
• ‘Grinding’, crunching, clicking or popping noises are frequently heard with movement of the knee, particularly with heavier loading like squatting or climbing stairs.
• Pain is commonly aggravated by walking, running, going up and down stairs, kneeling or sitting for prolonged periods with a bent knee.
• In some patients, the knee may give a very transient sensation of collapse or 'give way'. This is thought to be a reflex inhibition of muscular control rather than a sign of any significant instability of the knee itself.
• Patello-femoral pain can affect any age group, from children and adolescents, to adults and the elderly.

TREATMENT - We can help!

Treatment for Patello-femoral pain is usually very successful.

• Firstly, we need to assess the alignment of your leg and address any specific biomechanical faults that may be causing your problem. This may include your foot position because of the way it impacts on leg alignment generally. If necessary, we may recommend you buy orthotics for your most commonly used shoes and we will often advise you on the right type of shoe for your foot position.
• We may use taping or recommend braces in some patients to help with the tracking of their patella.
• Manual treatment involves a large variety of different approaches including stretching, soft tissue massage, patella mobilisations, muscular retraining and more. Your Physio will guide you through the treatment options most suitable to you.
• A detailed program of exercises to address issues of muscular weakness or poor flexibility will be given to just about every patient with very few exceptions. For treatment to be successful, YOU MUST persevere with them under the guidance of your Physio. If you give up, the pain may win. Strengthening of the quadriceps is vital along with a balanced program of other exercise.
• Although treatment often fixes the problem (particularly if we resolve issues early and quickly), a minority of cases pose anatomical mal-alignment issues and/or articular cartilage damage that is too great for us to be able to change. If needed, we will refer you to your doctor for further investigation and will help you find a viable long term solution.