Understanding Patellofemoral Pain (PFP): Evidence-Based Management

Patellofemoral pain (PFP), also known as runner's knee or anterior knee pain, is a common condition characterised by pain around or behind the patella (kneecap). It often affects physically active individuals, particularly athletes and young adults, but can also occur in sedentary individuals. As a leading cause of knee pain, PFP can significantly impact daily activities and sports performance. In this blog post, we'll delve into the causes, symptoms, diagnosis, and evidence-based management of PFP to provide valuable insights for individuals seeking relief and rehabilitation.

Understanding Patellofemoral Pain:

The patellofemoral joint is the articulation between the patella and the femur (thigh bone). PFP arises from dysfunction of this joint, leading to abnormal forces and stress on the patella and surrounding structures. Common contributing factors to PFP include:

1. Muscular Imbalances: Weakness or tightness in the quadriceps, hamstrings, hip abductors, and hip external rotators can alter patellar tracking and biomechanics, predisposing individuals to PFP.

2. Biomechanical Factors: Malalignment of the lower extremity, such as excessive foot pronation (flat feet), genu valgum (knock-knees), or femoral anteversion, can increase the risk of PFP.

3. Overuse and Training Errors: Repetitive activities that involve running, jumping, squatting, or climbing stairs without adequate conditioning or progressive training can lead to PFP.

4. Structural Abnormalities: Anatomical variations such as patellar tilt, patellar alta (high-riding patella), or trochlear dysplasia (shallow groove in the femur) may predispose individuals to PFP.

Symptoms of PFP typically include:

- Pain around or behind the patella, especially with activities that load the knee joint (e.g., running, squatting, kneeling).

- Pain worsens with prolonged sitting, climbing stairs, or descending hills.

- Swelling, crepitus (grinding sensation), or a sensation of "giving way" in the knee may also be present.

Diagnosis and Assessment:

Diagnosing PFP involves a comprehensive assessment by a qualified healthcare professional, such as a physiotherapist or sports medicine physician. The evaluation may include:

1. Medical History: Inquiring about the onset, duration, and aggravating factors of knee pain, as well as previous injuries or activities.

2. Physical Examination: Assessing alignment, range of motion, strength, flexibility, and stability of the lower extremity, with a focus on the patellofemoral joint.

3. Functional Tests: Performing specific tests to reproduce symptoms and evaluate patellar tracking, such as the patellar apprehension test, patellar grind test, or dynamic knee alignment assessment.

4. Imaging Studies: While not always necessary, imaging modalities such as X-rays, MRI, or ultrasound may be used to rule out other structural abnormalities or pathologies.

Evidence-Based Management of PFP:

The management of PFP aims to alleviate pain, improve function, address contributing factors, and prevent recurrence. Evidence-based interventions may include:

1. Exercise Therapy: Targeted exercises to load and strengthen the quadriceps, hip abductors, and hip external rotators, as well as improve flexibility and neuromuscular control, are essential components of PFP rehabilitation.

2. Patellar Taping or Bracing: Some taping and bracing techniques may temporarily alter patellar alignment and reduce pain during activities.

3. Manual Therapy: Hands-on techniques such as soft tissue massage, joint mobilization, or myofascial release may help alleviate pain and improve joint mobility.

4. Biomechanical Assessment and Correction: Addressing underlying biomechanical factors through gait analysis, orthotic prescription, footwear modification, or biomechanical retraining can optimise patellofemoral mechanics.

5. Activity Modification and Load Management: Gradually modifying activities to reduce pain and load on the knee, as well as implementing proper warm-up and cool-down routines, can facilitate recovery and prevent overuse injuries.

6. Education and Self-Management: Providing education on proper biomechanics, training principles, injury prevention strategies, and self-care techniques empowers individuals to manage PFP and optimise their recovery.

Patellofemoral pain is a common and debilitating condition that requires a comprehensive and evidence-based approach for effective management. By understanding the causes, symptoms, diagnosis, and evidence-based interventions for PFP, individuals can take proactive steps towards pain relief, functional improvement, and long-term knee health. At our physiotherapy clinic, we are dedicated to providing personalised and evidence-based care to help individuals overcome PFP and return to their desired activities. If you or someone you know is struggling with knee pain or patellofemoral issues, don't hesitate to contact us for expert evaluation and treatment. Together, we can work towards a healthier, pain-free future.