From the Guidelines
Patellofemoral Pain Syndrome (PFPS) should be managed with a best practice guide that includes knee-targeted exercise therapy, education, and supportive interventions tailored to the individual patient's needs and preferences, as recommended by the most recent and highest quality study 1. The diagnosis of PFPS typically involves a clinical evaluation, including a physical examination to assess knee alignment, patellar tracking, and pain reproduction with activities like squatting. Imaging such as X-rays, MRI, or ultrasound may be used to rule out other conditions but aren't always necessary.
Key Components of Treatment:
- Exercise Therapy: Focus on quadriceps and hip strengthening exercises, particularly targeting the vastus medialis obliquus muscle and hip abductors, as well as stretching tight structures like the hamstrings, quadriceps, and iliotibial band 1.
- Education: 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.
- Supportive Interventions: May include prefabricated foot orthoses, manual therapy, movement/running retraining, or taping, decided on and tailored to a patient’s needs and preferences 1.
Additional Considerations:
- Pain management typically involves over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for short-term use (1-2 weeks) 1.
- Supportive measures include proper footwear, possibly with orthotics to correct biomechanical issues, and temporary use of patellar taping or bracing to improve tracking.
- Applying ice after activity (15-20 minutes several times daily) helps reduce inflammation.
- Most patients improve with these conservative measures within 4-6 weeks, but if pain persists beyond 3 months despite adherence to therapy, reassessment and consideration of corticosteroid injections or referral to orthopedic specialists may be warranted 1.
- Surgery is rarely needed and reserved for cases with clear structural abnormalities.
From the Research
Testing for Patellofemoral Pain Syndrome (PFPS)
- The diagnosis of PFPS is typically based on clinical presentation and physical examination, with no specific test confirmed to diagnose the condition 2, 3.
- A thorough physical examination, including assessment of quadriceps strength, hip strength, and foot biomechanics, is essential for identifying contributing factors to PFPS 4.
Treatment Options for PFPS
- Conservative Management: The first-line treatment for PFPS, including quadriceps strengthening exercises, hip strengthening exercises, and foot orthotics 2, 3, 4.
- Pharmacotherapy: Non-steroidal anti-inflammatory drugs (NSAIDs) may provide short-term pain relief, but their long-term effectiveness is limited 3, 5.
- Taping and Bracing: May be helpful in the short-term management of pain and improving function, but their exact mechanism is unclear 6.
- Injections: The evidence for their use in PFPS is limited, and more well-designed studies are needed to determine their effectiveness 6, 5.
- Exercise Therapy: Quadriceps strengthening exercises are supported by current evidence, while the effectiveness of other exercises, such as hip strengthening, is still being investigated 2, 3.