From the Guidelines
Patellofemoral pain syndrome typically presents as gradual onset diffuse retropatellar and/or peripatellar pain during activities such as squatting, stair ambulation, and running, as reported in the most recent study by 1. The symptoms of patellofemoral pain can be summarized as follows:
- Pain around or behind the kneecap that worsens with activities that load the knee joint
- A dull, aching pain at the front of the knee
- Pain when climbing or descending stairs, squatting, kneeling, or sitting with bent knees for extended periods
- A grinding or popping sensation in the knee
- Swelling after activity
- A feeling of instability or giving way
- Stiffness after prolonged sitting with bent knees According to the study by 1, people with patellofemoral pain are six times more likely to be anxious or depressed, and are on average less physically active, and have poorer health-related quality of life than their asymptomatic peers. The condition results from improper tracking of the patella (kneecap) in the femoral groove, leading to increased pressure on the cartilage and surrounding structures, as supported by the best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice, and expert clinical reasoning by 1. The most recent and highest quality study by 1 suggests that best practice for patellofemoral pain should include delivering knee-targeted exercise therapy, with supportive interventions as required, and education should underpin all interventions, adjusted to reflect the needs of the person. Key evidence gaps to be addressed by future high-quality research are also highlighted in the study by 1. Overall, the symptoms of patellofemoral pain can have a significant impact on a person's quality of life, and it is essential to provide evidence-based management and treatment to improve outcomes, as emphasized by the study by 1.
From the Research
Symptoms of Patellofemoral Pain
The symptoms of patellofemoral pain include:
- Pain behind or around the patella, also known as anterior knee pain, runner's knee, or chondromalacia patellae 2
- Peripatellar and/or retropatellar knee pain, which is typically non-traumatic in origin 3
- Pain that intensifies when the knee is flexed during weight-bearing activities, such as squatting, descending stairs, or jumping 4, 5
- Pain that worsens with prolonged sitting or descending stairs 4
- Poorly defined pain, localized to the anterior retropatellar and/or peripatellar region of the knee, which can be slow or acute in onset 5
Characteristics of Patellofemoral Pain
Patellofemoral pain is characterized by:
- Insidious onset of pain, which can restrict participation in physical activity, sports, and work 5
- Recurring and persistent symptoms, which can last for years 5
- Pain that accompanies lower-limb loading activities, such as running, jumping, or ascending/descending stairs 5
Diagnosis and Examination
Diagnosis and examination of patellofemoral pain involve:
- A thorough history, including the date of symptom onset, mechanism of injury, location and quality of pain, exacerbating and alleviating symptoms, and relevant past medical history 3
- Physical examination to identify specific impairments, assessing range of motion, muscle length, effusion, resisted isometrics, strength, balance, and postural control 3
- Objective assessments to guide treatment, progression, and clinical decision-making 3