Patellofemoral Pain Syndrome (PFPS)

Patellofemoral pain syndrome (PFPS) is a common condition that is defined by pain located around or behind the kneecap. The kneecap sits in a special groove at the front of the femur known as the trochlea groove. The kneecap helps us to bend and straighten our knees more effectively. Patellofemoral pain syndrome is a general term that describes pain in the front of or behind your knee, or around your kneecap (patella) ⁽¹⁾. Patellofemoral pain syndrome is also called ‘runner’s knee’ and anterior knee pain syndrome ^(5,4). It is a common, non-serious cause of knee pain that is usually linked to overuse rather than injury. It is often seen in younger adults who participate in sports, although anyone can be affected, including those who are sedentary.

Patellofemoral pain syndrome is very rarely linked to a direct injury to the knee. Most often it develops gradually because of increased loads placed upon the knee, combined with biomechanical factors such as having flat feet (over-pronation) or tighter muscles (such as the hamstrings and quadriceps). The combination of increased load on the area and biomechanical changes can result in overload and sensitisation of the surface of the kneecap that sits within the trochlea groove. It used to be felt that the cause of pain was weakness or softening of the cartilage that lines the back of the kneecap. However, recent research has shown physical signs identified on imaging have poor correlation with the person’s levels of activity, pain and disability ⁽⁷⁾.

Patellofemoral pain syndrome is a common cause of knee pain in adolescents and young adults, especially among those who are physically active and regularly participate in sports. Patellofemoral pain syndrome is also called ‘runner’s knee’ and anterior knee pain syndrome ^(4,5).

Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis. Identification of various intrinsic and extrinsic factors that lead to patellofemoral pain syndrome will guide your treatment plan.

Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like an MRI or ultrasound scan are usually not required to achieve a working diagnosis, but in unusual presentations, they may be warranted.

As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your patellofemoral pain syndrome. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage. Before returning to sport, a rehabilitation programme should incorporate plyometric-based exercises; this might include things like bounding, cutting, and sprinting exercises ^(5,7).

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

Podiatry referral to address bio-mechanical issues in your feet may be helpful in the short term. However, there is a lack of quality evidence in regards to long-term value when it comes to patellofemoral pain syndrome. In the extremely unlikely scenario that performing your rehabilitation and modifying your activity does not settle your symptoms, you may be referred to see an orthopaedic surgeon (a doctor who specialises in the treatment of bone and joint disorders).

Patellofemoral pain syndrome | Health Information | Bupa UK

Patellofemoral Pain Syndrome – Physiopedia (physio-pedia.com)