From the Guidelines
The recommended treatment for patellofemoral pain syndrome primarily involves physical therapy focusing on quadriceps and hip strengthening exercises, particularly targeting the vastus medialis obliquus muscle, as supported by the most recent and highest quality study 1.
Key Components of Treatment
- Patients should perform exercises like straight leg raises, wall squats, and step-ups for 6-8 weeks, with 3-4 sessions per week, as part of a comprehensive approach to address the underlying biomechanical issues 1.
- Pain management can include over-the-counter NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (220-440mg twice daily) for short periods during flare-ups.
- Activity modification is essential—patients should temporarily reduce activities that aggravate symptoms, like running, jumping, or climbing stairs.
- Supportive measures include proper footwear, possibly with over-the-counter orthotics, and patellar taping or bracing in some cases.
- 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.
Additional Considerations
- 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 1.
- 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 1.
Expected Outcomes
Most patients see significant improvement within 4-6 weeks of consistent therapy, though complete resolution may take 3-6 months, as noted in the study 1.
From the Research
Treatment Options for Patellofemoral Pain Syndrome
The recommended treatment for patellofemoral pain syndrome (PFPS) includes:
- Physiotherapy, which is the most common physical intervention and includes specific vastus medialis obliquus or general quadriceps strengthening and/or realignment procedures (tape, brace, stretching) 2
- A multimodal approach, which combines thrust and nonthrust manipulation, trunk and hip stabilization exercises, patellar taping, and foot orthotics 3
- Strength training and stretching programs, which have traditionally been the mainstay of patient treatment 4
- Quadriceps and hip strengthening combined with stretching in a structured physiotherapy program, which is the most effective treatment for reducing knee pain symptoms and improving functionality in patients with PFPS 4
Efficacy of Treatment Options
Studies have shown that:
- Physiotherapy interventions have significant beneficial effects, but comparison with a placebo group is required to determine efficacy 2
- A 6-week regimen of physical therapy is efficacious for alleviation of patellofemoral pain 5
- A multimodal approach can result in decreased pain and clinically significant improvement in function, with gains maintained at 6-month follow-up 3
- Strength training and stretching exercises are effective treatment options for runners with PFPS 4
- Surgical and pharmacologic therapies are not effective for the management of patients with PFPS 4
Adjunctive Therapies
Adjunctive therapies, such as: