Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome (PFPS) is pain that occurs at the front of the knee localized at the patella (kneecap). PFPS is sometimes referred to as runner’s knee. It is common in people who repeatedly load the knee joint with jumping, squatting, bending and sport activities. Pain can increase with going up/downstairs, getting up from a seated position and with bending/squatting activities.  

Knee Anatomy

The patella is a small, circular bone that is positioned between your tibia (lower leg) and femur (thigh bone). The surfaces of the tibia and femur meet together to create the knee joint. When the knee is bending, the patella glides down towards the tibia. When the knee is straightening, the patella glides upwards towards the femur. Underneath the patella is a layer of cartilage that provides cushioning between the patella and knee joint. The cartilage allows the patella to move smoothly on top of the knee joint as the knee bends and straightens.  

Causes

Degenerative changes of the knee joint and patella can lead to maltracking of the patella. Sharp pain can occur due to lack of congruency of the patella and knee joint. The pain is more profound when bending the knee in weight-bearing positions that load the front of the knee. For example, pain can occur with going up/downstairs and squatting.

Muscle imbalances, weakness or lack of flexibility of the hip and knee joints can put stress on the patella and cause it to maltrack as well. Sport activities that involve repeated jumping, running and quick movements can put stress on the front of the knee and lead to inflammation of the knee. The inflammation can interfere with the patella tracking and create pain. 

Treatment

With an acute knee injury, it is best to rest, ice and elevate the knee. Wearing a knee compression sleeve can help reduce swelling. To further assess the knee, it is best to consult with an orthopedic knee specialist. An X-ray will be taken to assess degenerative changes, alignment and integrity of the patella and knee joint. The doctor can prescribe any needed medication for pain and inflammation.

Once a consultation is completed with the orthopedic specialist, the patient is usually referred to physical therapy. The physical therapist will do an evaluation that examines the patient’s gait mechanics, standing posture, muscle strength, flexibility and joint mechanics. Specific exercises will be given to strengthen weak muscles of the hip and knee. Kinesio taping can be done to improve alignment of the patella with bending/squatting activities. Stretching tight tendons that attach to the hip and knee can improve patella tracking. Exercises will be progressed per the patient’s tolerance. The physical therapist will develop a plan for the patient to return to specific activities, running and sports.