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 as required, based on a thorough assessment of the patient's background risk factors, symptoms, and physical impairments 1.
Diagnosis and Testing
PFPS is typically diagnosed through clinical evaluation, with testing options including:
- 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
Treatment
Treatment begins with conservative approaches including:
- Activity modification to reduce pain-provoking movements and relative rest
- Physical therapy as the cornerstone of treatment, focusing on quadriceps and hip strengthening exercises, particularly targeting the vastus medialis obliquus muscle and hip abductors
- Stretching tight structures like the hamstrings, quadriceps, and iliotibial band is also beneficial
- Pain management typically involves over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for short periods of 1-2 weeks
- Kinesiology taping, patellar bracing, or foot orthotics may help improve patellar tracking and reduce pain
- Ice can be applied for 15-20 minutes after activity to reduce inflammation
- 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
Supporting Interventions
Supporting interventions such as:
- Prefabricated foot orthoses should be prescribed to those who respond favourably to treatment direction tests and be customised for comfort by modifying density and geometry
- Movement/running retraining can be considered in those with symptoms reasoned to be associated with assessment findings aligning with the intervention
- Taping should be considered for people where rehabilitation is hindered by elevated symptom severity and irritability
- Manual therapy, lower quadrant manual therapy, and perineural dextrose injection combined with hip-and-knee-targeted exercise therapy may be considered, but no clear guidance on their application could be derived from the available evidence 1
Outcome
Most patients improve with these conservative measures within 4-6 weeks, and these approaches work by addressing biomechanical factors that contribute to abnormal patellar tracking and excessive pressure on the patellofemoral joint, reducing inflammation and strengthening supporting structures to better distribute forces across the knee 1.
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.