Patellofemoral Pain Syndrome: Causes, Symptoms, and Treatment

What Is Patellofemoral Pain Syndrome?

Patellofemoral Pain Syndrome (PFPS) refers to a group of symptoms that involve pain around the patella (kneecap) and the femur (thigh bone), often arising from improper tracking of the patella as the knee bends and straightens. This condition is common in athletes who engage in running, jumping, and other high-impact sports, but it can also affect people who engage in repetitive or prolonged activities like squatting, climbing stairs, or sitting with bent knees for long periods.

Causes of Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome is usually caused by an imbalance or abnormality in the way the patella moves within its groove in the femur. The primary causes include:

Overuse or Repetitive Activity

• Athletic Activity: Activities like running, jumping, or cycling put repetitive stress on the knee joint and can cause the patella to track incorrectly, leading to PFPS.

• Prolonged Sitting: Sitting for long periods with the knees bent can place pressure on the patella, leading to irritation and pain.

Muscle Imbalances or Weakness

• Weak Quadriceps: The quadriceps muscles (located in the front of the thigh) are responsible for controlling the movement of the patella. If these muscles are weak or not functioning properly, the patella may track abnormally, causing pain.

• Tight Hamstrings or Iliotibial Band (ITB): Tightness in the hamstrings or ITB can affect the knee's ability to move smoothly, contributing to PFPS.

• Poor Hip Muscle Strength: Weakness in the hips, particularly the hip abductors and external rotators, can contribute to abnormal alignment of the lower extremities, leading to PFPS.

Poor Biomechanics or Alignment

• Flat Feet or Overpronation: Abnormal foot mechanics, such as flat feet or overpronation (excessive inward rolling of the foot), can lead to misalignment of the knee, placing strain on the patella.

• Excessive Q-Angle: The Q-angle is the angle formed between the quadriceps muscle and the patellar tendon. An increased Q-angle, often seen in women, can alter the alignment of the patella, making it more prone to tracking issues and pain.

Injury or Trauma

• Direct Injury: A blow to the knee or a sudden trauma, such as a fall, can cause damage to the patella or the surrounding structures, leading to PFPS.

• Patellar Subluxation or Dislocation: If the patella moves out of its normal position, it can cause pain and inflammation, leading to PFPS.

Symptoms of Patellofemoral Pain Syndrome

The hallmark symptom of PFPS is pain in the front of the knee, which can vary in intensity depending on the activity and severity of the condition. Common symptoms include:

• Knee Pain: Pain is often felt around or behind the kneecap and may worsen with activities such as running, squatting, climbing stairs, or sitting for long periods with the knee bent.

• Swelling: Some individuals experience mild swelling around the knee, particularly after physical activity.

• Crepitus (Popping or Grinding Sensation): A sensation of popping, grinding, or cracking may be felt when bending or straightening the knee. This is due to abnormal patellar tracking.

• Knee Weakness or Instability: The knee may feel weak or unstable, making it difficult to perform activities that involve squatting, jumping, or climbing stairs.

• Pain After Prolonged Sitting: Often referred to as "theater knee," this is pain that occurs after sitting with the knee bent for long periods, such as during a movie or in meetings.

Diagnosing Patellofemoral Pain Syndrome

Clinical Examination

A healthcare provider will assess your symptoms and perform a physical examination to evaluate the knee's range of motion, muscle strength, and patellar tracking. They will also check for signs of swelling, tenderness, and other issues.

Imaging Studies

• X-rays: X-rays may be used to rule out bone fractures, joint problems, or structural abnormalities in the knee.

• MRI: An MRI may be recommended if there is concern about soft tissue damage, cartilage degeneration, or abnormalities in the patellar alignment.

Treatment for Patellofemoral Pain Syndrome

Non-Surgical Treatment

1. Rest and Activity Modification

   • Avoid Aggravating Activities: Limiting activities that exacerbate the pain, such as running or squatting, is crucial in the early stages of treatment.

   • Cross-Training: Low-impact activities, such as swimming or cycling, may help maintain fitness without stressing the knee.

2. Ice and Anti-Inflammatory Medications

   • Ice Therapy: Applying ice to the knee for 15–20 minutes several times a day can help reduce pain and swelling.

   • NSAIDs: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to alleviate pain and inflammation.

3. Physical Therapy

   • Strengthening Exercises: Targeting weak muscles, particularly the quadriceps, is key in improving patellar tracking and reducing pain. Strengthening the hip and core muscles is also important for overall lower limb alignment.

   • Stretching: Stretching tight muscles, such as the hamstrings, calves, and ITB, can help improve knee mechanics.

   • Patellar Taping: In some cases, patellar taping or bracing can help guide the patella into proper alignment during activity.

4. Foot Orthotics

   • Custom Footwear or Orthotics: If abnormal foot mechanics (such as flat feet or overpronation) are contributing to the condition, custom foot orthotics or supportive footwear may be recommended.

5. Knee Braces

   • Patellar Stabilizing Braces: A knee brace that stabilizes the patella may be recommended during physical activity to help manage symptoms.

Surgical Treatment

In rare cases, when non-surgical treatments do not provide relief, surgical options may be considered. These can include:

1. Realignment Surgery: If the patella is not tracking correctly due to alignment issues, surgery may be performed to realign the patella and correct any abnormal biomechanics.

2. Patellar Resurfacing: In cases where there is significant cartilage damage, patellar resurfacing or smoothing may be necessary to restore smooth movement.

Recovery and Prognosis

• Non-Surgical Recovery: With conservative treatments such as physical therapy and activity modification, most people with PFPS can recover within 6–12 weeks. Ongoing exercises to strengthen the knee and improve flexibility are essential to prevent recurrence.

• Post-Surgical Recovery: If surgery is required, recovery can take several months. A structured rehabilitation program will help to restore strength, mobility, and function in the knee.

Preventing Patellofemoral Pain Syndrome

• Strengthen the Muscles Around the Knee: Regular strength training, especially for the quadriceps, hamstrings, and hip muscles, can help maintain knee health and prevent PFPS.

• Proper Warm-Up: A proper warm-up and cool-down routine, including stretching and mobility exercises, can reduce the risk of injury and strain on the knee.

• Avoid Overtraining: Gradually increasing the intensity and volume of physical activity can help prevent overuse injuries, such as PFPS.

• Footwear and Orthotics: Wearing appropriate footwear and using orthotics can help maintain proper alignment and prevent stress on the knee joint.

Patellofemoral Pain Syndrome is a common knee issue that can significantly affect daily activities and athletic performance. Early diagnosis and treatment are essential to reduce symptoms and prevent further complications. If you are experiencing knee pain or suspect PFPS, contact Palms Physiotherapy & Allied Health to schedule an appointment with one of our specialists. Let us help you recover and return to your normal activities!