Patello-femoral Pain (PFP) Syndrome

What is Patello-femoral Pain (PFP) Syndrome?

Patello-femoral pain syndrome is commonly associated with pain felt behind the knee cap. Activities like walking up and down stairs or getting up from sitting after prolonged periods of time can exacerbate the pain. The most common cause of Patello-femoral pain syndrome is abnormal movement of the kneecap as the knee is bent and straightened. This may lead to wear and tear of the cartilage on the back of the kneecap. Tight muscles, structural abnormalities and weakness of the lower limb may contribute to the pain.

Typical Symptoms

1. Gradual onset of pain around the knee cap which is often vague and nonspecific.
2. Often aggravated by stairs, hill climbing, walking, running, squatting, kneeling or prolonged sitting.

How common is PFP?

1. PFP most frequent knee pain in adults under 50 and often occurs before osteoarthritis.
2. Individuals with osteo- arthritis (wear and tear of the cartilage behind the knee cap) are more likely to have had PFP as younger individuals. Hence, prevention and early management is very important.
3. 17% of Runners get PFP.
4. Females, post puberty are more likely to get PFP than males.

What causes PFP?

1. Multifactorial. Research shows that PFP has many causes and the cause of the symptoms varies from patient to patient. These factors are split up into extrinsic and intrinsic factors.

Intrinsic Factors

1. Knee cap (Patella) mal-alignment and mechanics
2. Weak and poor timing of VMO (inner thigh Quadriceps muscle)
3. Tightness in soft tissues surrounding the knee cap.
4. Bony or structural abnormalities around the knee cap eg Patella Alta where the knee cap sits high out of the knee joint, lengthening the patella tendon.
5. Poor tracking of the knee cap with sport/walking etc…

Extrinsic Factors

1. Poor foot mechanics, particularly pronators, people that roll their feet inwards.
2. Poor gluteal (buttock) muscles strength
3. Loading up running and sport too quickly. Eg going from no running to running 20 kilometres in 2 weeks.
4. High BMI (Body Mass Index)

How can a Physiotherapist Help?

On visiting a physiotherapist:

1. the therapist will perform a detailed assessment working out which intrinsic and extrinsic factors have caused your particular case of patello-femoral pain.
2. Rule out any other pathologies which may be causing your knee pain with a detailed assessment.
3. Imaging such as an X-Ray o MRI may be ordered if the therapist suspects other pathologies. But these are only ordered if the therapist thinks they will be helpful for the management of your knee pain.

Treatment

As the causes of patella- femoral pain are varied the treatments are also highly variable depending on which factors have led you to have your knee pain. The goal of the treatment is to help with your pain but also prevent it from coming back repetitively. The treating physiotherapist may use the following treatments:

1. Massage of the Soft Tissues around your knee cap
2. Taping of the knee cap to prevent mal-tracking
3. Orthotics to help correct foot mechanics
4. Exercises to strengthen and work on timing of the VMO muscle
5. Exercises to strengthen the Gluteal (buttock) muscles
6. Electrotherapy and Ultrasound if there is excessive inflammation
7. Exercises to stretch tight muscles
8. Advise to lose weight
9. Correct footwear advice

The most common treatment approach for PFP is conservative treatment with your physiotherapist but there are some rare cases which may require surgical intervention. If this is the case your physiotherapist will advise you and refer you to an Orthopaedic Surgeon specialising in knee surgery.

Prevention Strategies

1. Wear the right footwear
2. Stretch and warm up before exercise
3. Cool down after exercise by performing light stretches
4. Build up an exercise program slowly over time
5. Avoid sudden jarring motions and turn through the balls of your feet when changing direction, rather than twisting through your knees

Things to Remember

1. Seek early advice from your Physiotherapist if you think you are suffering from PFP.
2. It is a complex injury which is multifactorial and needs professional assessment and treatment.
3. It is very treatable with the right advice!