What is the likely diagnosis and treatment for a jogger with anterior knee pain that worsens with activities such as ascending or descending stairs or jogging?

Patellofemoral Pain Syndrome (PFPS)

This jogger most likely has patellofemoral pain syndrome (PFPS), and the treatment should be knee-targeted exercise therapy combined with hip strengthening exercises, underpinned by patient education about the benign nature of the condition. 1, 2

Clinical Diagnosis

The presentation of anterior knee pain worsening with stair climbing (both ascending and descending) and jogging is pathognomonic for PFPS. 2, 3 This is the most common cause of knee pain in the outpatient setting, accounting for 11-17% of all knee pain presentations. 2

Key diagnostic features to confirm:

• Gradual onset diffuse retropatellar or peripatellar pain (not sudden onset) 1, 4
• Pain provoked by activities requiring knee flexion under load: squatting, stairs, prolonged sitting, running 1, 2, 3
• Inferolateral patellar tenderness on examination 2
• Pain with resisted leg extension in full knee extension 1

No imaging is needed initially - the clinical presentation alone is diagnostic when the examination is consistent with PFPS. 2 A normal MRI, if obtained, would rule out structural abnormalities (meniscal tears, ligamentous injuries, osteochondral lesions) and confirm PFPS. 2

Primary Treatment Protocol

Exercise therapy is the cornerstone of treatment and must include both knee-targeted and hip-targeted exercises. 1, 2, 4

Knee Exercises

• Quadriceps strengthening exercises should be prescribed 1, 3
• Both open kinetic chain (foot not in contact with surface) and closed kinetic chain (foot in contact with surface) exercises are equally effective 3, 5
• Examples include leg extensions, squats, and step-downs 1

Hip Exercises (Critical Component)

• Hip abductor strengthening is essential - side-lying leg raises and clamshells specifically 2, 4
• Hip plus knee exercises provide clinically important pain reduction compared to knee exercises alone (mean difference -2.20 on 0-10 scale) 3
• Hip weakness is a common contributing factor that must be addressed 2

Patient Education (Non-Negotiable)

• Explain that pain does not correlate with tissue damage 2, 4
• PFPS is caused by imbalances in forces controlling patellar tracking, not progressive joint destruction 2
• Set realistic expectations: improvement requires consistent exercise adherence 4
• Over 50% of patients report persistent pain beyond 5 years when they fail to persist with exercise therapy or over-rely on passive treatments 1, 2

Adjunctive Treatments (Add Based on Individual Response)

Prefabricated foot orthoses should be considered, particularly if the patient has foot pronation or pes planus contributing to malalignment. 1, 6, 4 These are most beneficial in the short term. 4

Manual therapy (soft tissue mobilization of lateral retinacular structures and iliotibial band) can facilitate exercise therapy when high symptom severity or fear of movement hinders rehabilitation. 1, 4

Taping (patellar taping) may be used as an adjunct to reduce pain and facilitate exercise participation. 1, 4

Movement/running retraining should be tailored to the patient's specific biomechanical deficits if identified. 1

Critical Pitfalls to Avoid

Focusing only on knee exercises without addressing hip strength is a frequent error that leads to treatment failure. 2, 4 The evidence clearly shows hip plus knee exercises are superior to knee exercises alone. 3

Over-reliance on passive treatments (taping, manual therapy alone) without emphasizing active exercise therapy leads to poor long-term outcomes. 2, 4

Inadequate patient education about the benign nature of the condition and the importance of exercise persistence contributes to the high rate of chronic symptoms. 2

Ordering excessive imaging is not indicated unless symptoms fail to improve with appropriate conservative management. 2, 4

Reassessment Timeline

If no improvement after 6-8 weeks of consistent therapy, reassess the diagnosis. 2, 4 At that point, consider radiographs to rule out patellofemoral osteoarthritis, osteophytes, or loose bodies. 2, 4 MRI may be warranted if structural pathology is suspected. 2

The expected outcome with proper treatment is clinically important pain reduction (mean difference -1.46 on 0-10 scale) and functional improvement (12.21 points on 0-100 Anterior Knee Pain Score). 3 However, this requires patient adherence to the exercise program and understanding that passive treatments alone are insufficient. 1, 2