Patello-Femoral Pain Syndrome

27 Mar 15 - 09:39 AM

Patello-Femoral Pain Syndrome is one of the most common presentations to sport injury clinics, it is characterised by pain around and behind the knee cap.

Patello-Femoral Pain Syndrome (PFPS) has been shown to be one of the most common causes for a visit to a sports injury clinic, PFPS is characterised by a history of a general ache at the front of the knee, often aggravated by running (especially downhill), walking up and down stairs and sitting for prolonged periods with the knee bent (extending the knee often relieves the pain). Pain is generally though to be caused by an increase in tension of the knee extensors or the quadricep muscle group (of which all tendons join onto the patella 'knee cap').

A routine history and examination usually demonstrates some of the following:

  • An increase in physical activity
  • A patella that is not tracking correctly in the femoral groove
  • Imbalances in quadricep muscle strength (lateral or medial fibres causing an increase lateral pull, impacting the patella on the femur causing pain)
  • Anatomical tightness for example, ITB tightness which is extremely common in runners

All of these problems lead to an overuse type injury at the patello-femoral joint and can lead to thinning and softening of the articular surfaces at the patellofemoral joint, synovial irritation and inflammation and subchondral bony changes in the distal femur or patella known as "bone bruises". The longer the underlying cause is left untreated the more chronic the condition can become, and may even lead to early degeneration at the patello-femoral joint.

Most individuals presenting with PFPS respond well to conservative treatments, with evidence showing a prescribed exercise program and manual therapy effective in decreasing pain and improving function.

A strengthening program focusing on the quadricep muscles can help address any muscular imbalances which may be causing a shift in patellar movement, before initiating a strengthening program it is important to assess the quadricep muscles to see which individual component needs to be addressed (with it usually being a weak VMO muscle), this can be assessed by your chiro or physio. It is also important to note that this may aggravate the symptoms so there needs to a balance between appropriate intensity for strengthening as well as pain management and control, this balance usually improves with time as strength increases.

Your Chiro or Physio can also address any structural causes of the PFPS, lengthening any tight musculature ie ITB or vastus lateralis through soft tissue work and the implementation of a stretching program, and also mobilising any restricted joint motion which may be contributing to poor patello-femoral movement.

While PFPS is a very common injury it is also very treatable and with the right combination of rehab exercises, stretching and biomechanical correction you will be pain free in next to no time! 


Patello-Femoral Pain Syndrome