From the Guidelines
Patellofemoral pain syndrome (PFPS) should be treated with a primary intervention of exercise therapy and education, as recommended by the best practice guide based on a synthesis of a systematic review, the patient voice, and expert clinical reasoning 1. The diagnosis of PFPS involves a thorough assessment of the patient's presentation, including objective evaluation of physical impairments such as muscle strength, movement patterns, tissue tolerance to load, and patellofemoral joint structure and function 1. Key factors to consider in the diagnosis and treatment of PFPS include:
- Muscle imbalances, particularly weakness in the quadriceps and hip muscles
- Biomechanical factors such as flat feet or knock knees
- Overuse or repetitive strain on the knee joint
- Abnormal tracking of the patella within the femoral groove Treatment should be tailored to the individual patient's needs and may include:
- Knee-targeted exercise therapy, with a focus on quadriceps and hip strengthening exercises
- Education to challenge inaccurate beliefs, build confidence, and promote understanding of the diagnosis and recovery journey
- Supporting interventions such as patellar taping, bracing, or prefabricated foot orthoses, as needed
- Movement or running retraining to address symptoms associated with assessment findings The primary goal of treatment should be to deliver exercise therapy and education, with supportive interventions added as required, to improve patient outcomes and reduce symptoms 1.
From the Research
Diagnosis of Patellofemoral Pain Syndrome (PFPS)
- A thorough history is critical for appropriately diagnosing and optimally managing PFPS, including 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 2.
- 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 2.
Treatment of Patellofemoral Pain Syndrome (PFPS)
- Exercise therapy, including hip, knee, and core strengthening as well as stretching and aerobic exercise, are central to the successful management of PFPS 2, 3, 4.
- Other complimentary treatments may include patellofemoral and tibiofemoral joint mobilizations, patellofemoral taping, neuromuscular training, and gait retraining 2, 3, 5.
- Physiotherapy interventions have significant beneficial effects, but comparison with a placebo control is required to determine efficacy 3.
- A six-treatment, 6-week physical therapy regimen is efficacious for alleviation of patellofemoral pain 6.
- Taping and bracing may be helpful for patients in the short-term management of pain and improving function, but the evidence for their use is limited 3, 5.
- Injections, such as platelet-rich plasma (PRP), sclerosing, high volume, or stem cell injections, are an exciting new area in the treatment of patellar tendinopathy, but the evidence for their use is limited and more well-designed studies are needed 5.