What is the diagnosis and treatment for patellofemoral pain syndrome (PFPS)?

From the Guidelines

Patellofemoral pain syndrome should be managed with a best practice guide that includes delivering knee-targeted exercise therapy, with supportive interventions as required, and education should underpin all interventions, adjusted to reflect the needs of the person. This approach is based on the most recent and highest quality study available, which synthesizes multiple data streams including data from randomized controlled trials and interviews with patients and clinical experts 1. The study emphasizes the importance of tailoring interventions to the individual patient's presentation following a thorough assessment.

Key components of the management plan include:

• Delivering knee-targeted exercise therapy, with a focus on hip and knee strengthening exercises, particularly for patients with poor tolerance to loaded knee flexion 1
• Providing education to challenge inaccurate beliefs, build confidence and understanding of the diagnosis, and promote autonomy and reduce fear 1
• Considering supportive approaches such as prefabricated foot orthoses, movement/running retraining, and taping, based on subjective and objective findings 1
• Regularly reassessing the patient's response to treatment and adjusting the intervention as needed to ensure optimal outcomes.

It is essential to prioritize education and exercise therapy in the management of patellofemoral pain syndrome, as these interventions have been shown to improve outcomes and reduce symptoms 1. By following this best practice guide, clinicians can provide effective and personalized care for patients with patellofemoral pain syndrome, ultimately improving their quality of life and reducing morbidity and mortality.

From the Research

Definition and Overview of Patellofemoral Pain Syndrome

• Patellofemoral pain syndrome (PFPS) is a common clinical presentation characterized by retropatellar pain or peripatellar pain when ascending or descending stairs, squatting, or sitting with flexed knees 2.
• The etiology, structures causing the pain, and treatment methods are debated in the literature, but consensus has not been reached so far 2.

Treatment Options for Patellofemoral Pain Syndrome

• Exercise therapy to strengthen the quadriceps is often prescribed, though its efficacy is still debated 2.
• A comprehensive contemporary guide to conservative management of PFPS outlines key considerations for clinicians to follow, including multimodal intervention, exercise to strengthen the gluteal and quadriceps musculature, manual therapy, and taping 3.
• Strength training and stretching exercises continue to be strongly supported by research as effective treatment options for runners with PFPS 4.
• Recent studies have confirmed that quadriceps and hip strengthening combined with stretching in a structured physiotherapy program comprise the most effective treatment for reducing knee pain symptoms and improving functionality in patients with PFPS 4.

Key Principles for Effective Management of Patellofemoral Pain Syndrome

• Four key over-arching principles to ensure effective management include:
  1. PFPS is a multifactorial condition requiring an individually tailored multimodal approach.
  2. Immediate pain relief should be a priority to gain patient trust.
  3. Patient empowerment by emphasizing active over passive interventions is important.
  4. Good patient education and activity modification are essential 3.
• The initial treatment plan should include quadriceps strengthening and temporary activity modification, with additional exercises incorporated as dictated by the findings of the physical examination 5.

Adjunctive Therapies for Patellofemoral Pain Syndrome

• Therapies such as proprioceptive training, orthotics, and taping may offer benefits as adjunctive therapies but do not show a significant benefit when used alone in patients with PFPS 4.
• Footwear should be closely evaluated for quality and fit, and the use of arch supports should be considered 5.
• Acupuncture and foot orthoses have also been found to be effective in the management of PFPS 3, 6.