What is the initial management for patellofemoral pain syndrome?

Initial Management for Patellofemoral Pain Syndrome

The initial management for patellofemoral pain syndrome should focus on knee-targeted exercise therapy combined with education as the primary intervention, with additional supporting interventions tailored to the patient's specific needs and presentation. 1, 2

Primary Interventions

• Knee-targeted exercise therapy should form the foundation of all treatment plans, focusing on quadriceps strengthening exercises, with hip exercises added based on individual assessment findings 1, 2
• Patient education must underpin all interventions, including explaining the diagnosis, clarifying that pain doesn't necessarily correlate with tissue damage, and setting realistic expectations about recovery timeframes 2, 3
• Exercise therapy should be active rather than passive to promote patient empowerment and self-management 3
• Immediate pain relief strategies should be implemented to gain patient trust while establishing longer-term interventions 3

Supporting Interventions (Based on Individual Assessment)

• Prefabricated foot orthoses may benefit patients who respond favorably to treatment direction tests, particularly providing short-term relief 2, 4
• Manual therapy can be used as an adjunct to facilitate exercise therapy, especially when rehabilitation is hindered by high symptom severity or fear of movement 2, 3
• Taping techniques, particularly medially directed patellar taping, can provide short-term pain relief and improved function to support exercise participation 2, 5
• Movement/running retraining may be beneficial for active patients to reduce patellofemoral joint stress during dynamic activities 2, 6

Assessment Considerations

• Understanding the patient's background risk factors, reasons for seeking care, and greatest symptoms is crucial for informing treatment selection 1, 2
• Evaluate key subjective factors including pain levels, fear of movement, and impact on daily activities and recreational pursuits 2
• Perform objective evaluation including hip and knee strength assessment and movement pattern analysis to identify potential contributing factors 2, 7
• For overweight patients, weight loss counseling should be included as part of the treatment plan 6, 5

Pharmacological Management (When Needed)

• NSAIDs (oral or topical) may be used for short-term pain relief, with topical formulations preferred to minimize gastrointestinal side effects 6, 5
• Acetaminophen (up to 4,000 mg/day) can be considered as initial pharmacologic therapy due to its favorable safety profile 6

Common Pitfalls to Avoid

• Failure to persist with exercise therapy and over-reliance on passive treatments can lead to poor outcomes, with over 50% of people reporting persistent pain more than 5 years post-diagnosis despite treatment 2, 3
• Neglecting to address modifiable risk factors such as obesity, muscle weakness, and biomechanical issues 6
• Overlooking the importance of patient education and self-management strategies 2, 3
• Complete immobilization should be avoided to prevent muscular atrophy and deconditioning 5, 8

Prognosis and Follow-up

• Regular reassessment of pain, function, and treatment response is necessary to adjust interventions as needed 6
• Patellofemoral pain has a poor prognosis if not managed appropriately, with patients being six times more likely to experience anxiety or depression 2
• Early aggressive management is crucial to prevent disease progression and maintain function, particularly in younger patients 6