Patellofemoral Pain
Even though the terminology used to describe Patellofemoral pain can be confusing and sometimes used inconsistently, those who suffer from it are sure about being in pain.
If you have been diagnosed with idiopathic anterior knee pain, runner’s knee, retropatellar pain syndrome or lateral facet compression syndrome, it’s best in the long run to not let the pain around or behind your kneecap rule your quality of life.
What does patellofemoral pain feel like?
I struggle at work, bending down to get bottom shelf and getting back up, I literally have to hold onto the table to pull myself up. I can’t do it off just my knees.[1]
I’ve missed out on things over the years, spending time with friends, spending time with family and that kind of thing, because I’ve not been able to do it.
The pitfalls of fear of movement, fear of re-injury and movement avoidance
Many people exacerbate their patellofemoral pain during simple daily activities like squatting, going up and down stairs and running. This can lead to a fear that these movements are causing damage, resulting in an avoidance of physical activities that may actually be beneficial if done in the right set and setting.[2]
Activity avoidance caused by fear of movement has also been shown to contribute to weight gain or increases in body mass index (BMI). Considering a higher BMI is also associated with higher pain in individuals with patellofemoral pain, your Lane Cove physio might seek to address this snowball effect feature in order to improve weight management and pain in the long run.[3]
Treating your patellofemoral pain at Lane Cove physio
First of all, your physio will look to distinguish patellofemoral pain from patellofemoral osteoarthritis, patellofemoral instability, and similar conditions that cause anterior knee pain. Patellofemoral osteoarthritis generally occurs in patients who are older than those who develop patellofemoral pain and there is no known link between patellofemoral pain and patellofemoral osteoarthritis. People with patellofemoral instability may also have a history of patellar dislocation or describe a sensation of instability or movement of the patella. Both of these disorders, while related to patellofemoral pain, require specific treatments distinct from those used to treat it.[4]
The goals of physiotherapy treatment for patellofemoral pain are to:
- reduce pain,
- improve patellofemoral tracking and alignment,
- and return you to as a high a level of pain-free function as possible.
The acute phase of treatment during the first week focuses on pain control; the subsequent recovery phase focuses on modification of risk factors and biomechanical deficits.
Most experts believe that overload plays an important role in the development of patellofemoral pain and we will usually advise a need to avoid activities that cause pain during rehabilitation.
Most runners will need to reduce their running volume and those with severe signs or symptoms like limping, should stop all running activities.
There is no evidence to support the long-term use of anti-inflammatory NSAIDs for the treatment of patellofemoral pain and according to one systematic review, limited evidence supports their use in the short term (two to three weeks).[5]
Recovery phase
Evidence from the consensus statement from the 5th International Patellofemoral Pain Research Retreat suggests that a combination of knee and hip exercises to increase lower extremity strength, mobility, and overall function represents the most effective intervention for those suffering patellofemoral pain. In addition, the consensus statement from this retreat endorsed combined interventions such as exercise therapy plus foot orthoses, patellar taping, and manual therapy.[6]
A comprehensive approach to treatment will systematically address potential deficiencies in the groups of muscles and other structures involved in moving the lower body (ie, the lower body kinetic chain). These structures include:
- Hip abductors
- Iliotibial band
- Knee extensors (quadriceps)
- Knee flexors (hamstrings)
- Feet – Excessive or insufficient pronation
- Core muscles
If you’ve got questions about any type of knee injury, patellofemoral pain or related injury, Sports physios are experts to speak with. At Lane Cove Physio, we also understand the value of patient education in getting you back to what you were doing before the pain. If you are in pain, get in touch with us on (02) 9428 5772 or send us an email at info@lanecovephysio.com.au – don’t wait until the pain becomes severe or chronic.
[1] Smith BE, Moffatt F, Hendrick P, et al The experience of living with patellofemoral pain—loss, confusion and fear-avoidance: a UK qualitative study BMJ Open 2018;8:e018624. doi: 10.1136/bmjopen-2017-018624
[2] Glaviano NR, Baellow A, Saliba S 2017 Physical activity levels in individuals with and without patellofemoral pain. Physical Therapy in Sport 27: 12–16. doi:10.1016/j. ptsp.2017.07.002
[3] Hart HF, Barton CJ, Khan KM, Riel H, Crossley KM 2017 Is body mass index associated with patellofemoral pain and patellofemoral osteoarthritis? A systematic review and meta-regression and analysis. British Journal of Sports Medicine 51: 781–790. doi:10.1136/bjsports2016-096768
[4] Witvrouw E, Callaghan MJ, Stefanik JJ, et al. Patellofemoral pain: consensus statement from the 3rd International Patellofemoral Pain Research Retreat held in Vancouver, September 2013. Br J Sports Med 2014; 48:411.
[5] Heintjes E, Berger MY, Bierma-Zeinstra SM, et al. Pharmacotherapy for patellofemoral pain syndrome. Cochrane Database Syst Rev 2004; :CD003470.
[6] Collins NJ, Barton CJ, van Middelkoop M, et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med 2018; 52:1170.
