From the Guidelines
This patient likely has patellofemoral pain syndrome (PFPS) with lateral patellar tracking, as evidenced by her symptoms and X-ray findings, and I recommend starting with conservative management including daily quadriceps strengthening exercises, hamstring and IT band stretching, and core strengthening, as supported by the most recent and highest quality study 1. The patient's symptoms and X-ray findings suggest a diagnosis of PFPS, which is characterized by pain in the front of the knee, usually around or behind the patella. The X-ray findings of mild bilateral lateral patellar tracking with widening of the medial facet joint spaces bilaterally support this diagnosis.
Key Components of Conservative Management
- Daily quadriceps strengthening exercises, particularly vastus medialis obliquus, to improve patellar tracking and reduce pain
- Hamstring and IT band stretching to improve flexibility and reduce tension on the patella
- Core strengthening to improve overall lower extremity alignment and reduce stress on the knee joint
- Education on proper knee alignment and movement patterns to reduce stress on the patellofemoral joint
Additional Interventions
- Patellar taping or a patellar stabilizing brace may be considered to improve patellar alignment and reduce pain, as suggested by 1
- Modifying activities to avoid deep squats or prolonged sitting with bent knees, and temporarily reducing stair climbing when possible
- Physical therapy for 6-8 weeks to address biomechanical issues and provide supervised rehabilitation
- Custom orthotics may be considered if the patient has foot pronation contributing to knee alignment problems, as mentioned in 1
Importance of Individualized Approach
The management of PFPS should be individualized, taking into account the patient's specific symptoms, activity level, and biomechanical factors, as emphasized in 1. A comprehensive approach that addresses the underlying biomechanical issues and includes education, exercise, and lifestyle modifications can help improve symptoms and reduce the risk of long-term complications.
From the Research
Diagnosis and Treatment
- The patient's symptoms of bilateral knee pain behind the patella, particularly when walking up and down stairs, are consistent with patellofemoral pain syndrome 2.
- The X-ray findings of mild bilateral lateral patellar tracking with widening of the medial facet joint spaces bilaterally support this diagnosis 3.
Conservative Management
- Conservative management is the first-line treatment for patellofemoral pain syndrome, and may include physiotherapy, physical modalities, and orthotic devices 3, 2.
- A physical therapy program that employs quadriceps strengthening, manual stretching of the lateral patellar soft-tissue structures, patellar taping, and biofeedback may be successful in the majority of cases 2.
- The use of foot orthoses, such as knee braces or foot orthotics, may also be beneficial in reducing pain and improving function 4, 5.
Orthotic Devices and Interventions
- The evidence for the use of orthotic devices, such as knee braces or foot orthotics, is limited, but suggests that they may be effective in reducing pain and improving function in patients with patellofemoral pain syndrome 4.
- Patellar taping or bracing may also be beneficial in reducing pain and improving function, but the evidence is uncertain 5.
- Exercise therapy, particularly the combination of hip-focused and knee-focused exercises, is recommended to improve pain and/or function in people with patellofemoral pain 5.
Treatment Recommendations
- A multi-faceted approach to treatment, including physiotherapy, physical modalities, and orthotic devices, may be the most effective way to manage patellofemoral pain syndrome 3, 2.
- The use of combined interventions, such as exercise therapy and foot orthoses, may be more effective than a single intervention 5.
- Further research is needed to determine the most effective treatment strategies for patellofemoral pain syndrome 3, 4, 5.