From the Guidelines
Patellofemoral pain syndrome (PFPS) should be treated with a best practice guide that includes knee-targeted exercise therapy, supportive interventions as required, and education underpinning all interventions, as evidenced by the most recent and highest quality study 1. The diagnosis of PFPS is characterized by pain around or behind the kneecap that typically worsens with activities like climbing stairs, squatting, or sitting for long periods.
Key Components of Treatment
- Conservative measures including rest from aggravating activities and over-the-counter pain medications such as ibuprofen (400-600mg three times daily with food) or acetaminophen (500-1000mg every 6 hours as needed) for pain relief
- Physical therapy focusing on quadriceps and hip strengthening exercises, particularly the vastus medialis obliquus muscle which helps stabilize the kneecap
- Patients should perform exercises like straight leg raises, wall squats, and step-ups for 15-20 minutes daily for at least 6 weeks
- Ice can be applied for 15-20 minutes after activity to reduce inflammation
- Supportive footwear or orthotic inserts may help correct biomechanical issues, and a patellar stabilizing brace can provide additional support during activities
- Weight management is important as excess weight increases pressure on the patellofemoral joint
Duration and Follow-Up
Most cases improve within 4-6 weeks of consistent therapy, though some may require 3-6 months for complete resolution. If symptoms persist despite these measures, further evaluation by an orthopedic specialist may be necessary to rule out other conditions or consider additional interventions, as supported by the synthesis of a systematic review, patient voice, and expert clinical reasoning 1.
From the Research
Diagnosis of Patellofemoral Pain Syndrome
- The diagnosis of patellofemoral pain syndrome is based on a careful history and targeted physical examination 2, 3, 4
- A thorough history should include the date of symptom onset, mechanism of injury and/or antecedent events, location and quality of pain, exacerbating and alleviating symptoms, relevant past medical history, occupational demands, recreational activities, footwear, and patient goals 3
- Physical examination should identify the patient's specific impairments, assessing range of motion (ROM), muscle length, effusion, resisted isometrics, strength, balance and postural control, special tests, movement quality, palpation, function, and patient reported outcome measures 3
- Plain radiographs of the knee are not necessary for the diagnosis of patellofemoral pain syndrome but can exclude other diagnoses, such as osteoarthritis, patellar fracture, and osteochondritis 4
Treatment of Patellofemoral Pain Syndrome
- The treatment of patellofemoral pain syndrome includes rest, a short course of nonsteroidal anti-inflammatory drugs, and physical therapy directed at strengthening the hip flexor, trunk, and knee muscle groups 4
- Exercise therapy, including hip, knee, and core strengthening as well as stretching and aerobic exercise, are central to the successful management of patellofemoral pain syndrome 5, 3
- Other complimentary treatments may include patellofemoral and tibiofemoral joint mobilizations, patellofemoral taping, neuromuscular training, and gait retraining 3
- Patellar kinesiotaping may provide additional short-term pain relief; however, evidence is insufficient to support its routine use 4
- Surgery is considered a last resort 2, 4