What are the treatment options for Patellofemoral Pain Syndrome (PFPS)?

Treatment Options for Patellofemoral Pain Syndrome (PFPS)

Knee-targeted exercise therapy combined with education should be the primary intervention for patellofemoral pain syndrome, with additional supporting interventions tailored to the patient's specific presentation following thorough assessment. 1

Primary Interventions

Exercise Therapy

• Knee-targeted exercise therapy focusing on quadriceps strengthening should form the foundation of all PFPS treatment plans 1, 2
• Hip-targeted exercises should be incorporated based on individual assessment findings to address potential biomechanical contributors to patellofemoral pain 3, 2
• Progressive loading is essential, with exercise prescription based on pain response and functional limitations 1
• Strengthening exercises with the knee extended can help reduce patellofemoral pressure while still targeting quadriceps 3

Patient Education

• Education must underpin all interventions and should include:
  • Explanation of the diagnosis and pathophysiology 1, 2
  • Clarification that pain does not necessarily correlate with tissue damage, particularly in chronic cases 1
  • Setting realistic expectations about recovery timeframes 2
  • Activity modification strategies to manage load and reduce pain 1, 2
  • Emphasis on active over passive interventions to promote patient autonomy 4

Supporting Interventions

Prefabricated Foot Orthoses

• Beneficial for patients who respond favorably to treatment direction tests 1, 3
• Should be customized for comfort by modifying density and geometry 1
• Most effective in the short term, may not be necessary for long-term management 1, 3

Manual Therapy

• Can be used as an adjunct to facilitate exercise therapy 1, 2
• Particularly helpful when targeting the patellofemoral joint and surrounding soft tissues 3
• Should not replace active interventions but can help reduce pain to enable better exercise participation 1

Movement/Running Retraining

• Consider for active patients, especially runners with symptoms associated with specific movement patterns 1
• Interventions such as increasing cadence or step width can be beneficial for runners 1
• Should be aligned with assessment findings that correspond to the intervention 1, 2

Taping

• Consider when rehabilitation is hindered by high symptom severity or irritability 1, 2
• Can provide short-term pain relief to facilitate exercise participation 3, 5
• If no improvement is observed after a reasonable period, reassess the treatment approach 1

Pharmacological Management

• Short course of non-steroidal anti-inflammatory drugs (NSAIDs) may reduce pain in the short term 5, 6
• Acetaminophen (up to 4,000 mg/day) can be considered as initial pharmacologic therapy 3
• Topical NSAIDs may provide local anti-inflammatory effects with fewer systemic side effects 3

Treatment Algorithm

1. Begin with knee-targeted exercise therapy and comprehensive education 1
2. Add hip-targeted exercises based on assessment of hip strength and movement patterns 3, 2
3. Consider prefabricated foot orthoses if foot alignment issues are contributing to knee pain 1, 3
4. Implement taping or manual therapy if pain is limiting exercise participation 1, 2
5. Address movement patterns and running mechanics in active individuals 1
6. Consider short-term pharmacological management for pain relief 5, 6

Common Pitfalls to Avoid

• Overreliance on passive treatments without emphasizing active exercise 2, 4
• Failing to address modifiable risk factors such as obesity, muscle weakness, and biomechanical issues 3
• Neglecting to strengthen both quadriceps and hip muscles, which are essential for patellofemoral joint stability 3, 2
• Inadequate education about pain mechanisms and realistic recovery expectations 1, 2
• Continuing with interventions that show no improvement after a reasonable trial period 1

Prognosis

• PFPS has a poor prognosis if not properly managed, with over 50% of people reporting persistent pain more than 5 years post-diagnosis 1, 2
• Early, appropriate intervention focusing on active management strategies improves outcomes 3, 2
• Regular reassessment of pain, function, and treatment response is necessary to optimize outcomes 3