From the Guidelines
The most appropriate management for this 16-year-old female athlete with patellofemoral pain syndrome is a home-exercise prescription. This condition, commonly known as "runner's knee," presents with anterior knee pain that worsens with activities that increase patellofemoral joint stress, such as climbing stairs, squatting, or sitting for prolonged periods. The positive patellar grind test (pain with quadriceps contraction against pressure on the patella) confirms the diagnosis.
Key Considerations
- Home exercises focusing on quadriceps strengthening, particularly the vastus medialis obliquus muscle, along with hamstring and iliotibial band stretching, can effectively address the biomechanical imbalances causing the pain, as supported by experts in the field 1.
- These exercises help improve patellar tracking and reduce stress on the patellofemoral joint.
- Education should underpin all interventions, adjusted to reflect the needs of the person, and may seek to challenge inaccurate beliefs, build confidence and understanding of the diagnosis, and promote autonomy and reduce fear 1.
- Conservative management is appropriate as first-line therapy before considering more invasive options.
- High-dose NSAIDs carry risks of gastrointestinal and renal side effects, especially in young athletes.
- Corticosteroid injections are not indicated for this condition and may weaken tendons.
- Referral to specialists would be premature without first attempting conservative management, which has high success rates for patellofemoral pain syndrome.
Additional Interventions
- Prefabricated foot orthoses may be prescribed to those who respond favourably to treatment direction tests and be customised for comfort by modifying density and geometry 1.
- Movement/running retraining can be considered in those with symptoms reasoned to be associated with assessment findings aligning with the intervention 1.
- Taping should be considered for people where rehabilitation is hindered by elevated symptom severity and irritability 1.
From the Research
Management of Patellofemoral Pain Syndrome
The patient's symptoms, such as difficulty rising after sitting and going down stairs, and pain improving with walking, are consistent with patellofemoral pain syndrome (PFPS) 2, 3, 4, 5, 6.
Treatment Options
- The most appropriate management for PFPS is a combined physiotherapy program, including strength training of the quadriceps and hip abductors and stretching of the quadriceps muscle group 2.
- Proximal exercise programs, such as hip strengthening, have been shown to be effective in reducing pain and improving function in patients with PFPS 3.
- Exercise therapy, including quadriceps strengthening exercises, has been found to be effective in reducing anterior knee pain and improving knee function in patients with PFPS 4, 5.
- Physical therapy directed at strengthening the hip flexor, trunk, and knee muscle groups is a recommended treatment for PFPS 6.
Inappropriate Treatment Options
- High-dose nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for a short course, but are not a primary treatment for PFPS 6.
- Joint injections with corticosteroids are not a recommended treatment for PFPS 2.
- Referral to a podiatrist or an orthopedic surgeon may not be necessary unless conservative treatment measures are unsuccessful 6.