Patellofemoral pain can be defined as pain behind or around the patella. It is a dull, aching pain sensation around the front of the knee that worsens with activities that involve bending the knee. It is associated with tightness in specific muscles such as rectus femoris, grastronemius, and the iliotibial band (Samnasi et al., 2023). People may also experience crepitus and a reduced ability to perform physical activities sports, and work related activities. It is common for those with higher pain levels to develop a fear of physical activity (Rethman et al., 2023). Patellofemoral pain may precede the onset of patellofemoral osteoarthritis (Collins et al., 2017).

Aggravated by:

• Activities that load weight onto the patellofemoral joint on a flexed knee

• Squatting, walking up or down stairs, jogging/running, hopping/jumping

• Sitting for long periods of time with the knee bent

Who gets it:

• Active adolescents

• Physically active populations such as runners and cyclists

Causes:

• Overuse or load related

• Training errors

• Biomechanical factors

• Sport injuries

• Psychosocial factors

• Diagnosis:

• Diagnosis by exclusion

• Based on symptoms

• Palpation test, patellar tilt test, eccentric step test

• Imaging is not necessary

• Treatment:

• Exercise

• Combination of hip and knee exercises

• Aquatic training can reduce pain and improve function (Fang et al., 2022)

• Orthoses

• Patellar taping/mobilizations

• Different types of taping; McConnell taping is known to reduce pain (Yoon et al., 2023)

• Mindfulness-based intervention may improve short and long term pain (Priore et al., 2023)

• Gait modifications can lead to a decrease in pain with runners (Esculier et al., 2023)

• Whole body vibration combined with exercise leads to an increase in pain reduction (Yang et al., 2022)

• Botulinum neurotoxin A was proven to reduce pain, help balance the leg muscles, and improved how the knee cap moved (Pal et al., 2023)

Author’s Note: At Chronic Pain Hope we recommend using a biopsychosocial approach to treat any pain condition. Please consider mind-body approaches such as Pain Reprocessing Therapy when treating this pain condition.

Sources

Collins, N. J., Barton, C. J., van Middelkoop, M., Callaghan, M. J., Rathleff, M. S., Vicenzino, B. T., Davis, I. S., Powers, C. M., Macri, E. M., Hart, H. F., de Oliveira Silva, D., & Crossley, K. M. (2018). 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. British Journal of Sports Medicine, 52(18), 1170–1178. https://doi.org/10.1136/bjsports-2018-099397 

Esculier, J. F., Bouyer, L. J., & Roy, J. S. (2023). Running gait modifications can lead to immediate reductions in patellofemoral pain. Frontiers in sports and active living, 4, 1048655. https://doi.org/10.3389/fspor.2022.1048655

Fang, B., Kim, Y. H., & Choi, M. Y. (2022). Effects of High-Intensity Aquatic or Bicycling Training in Athletes with Unilateral Patellofemoral Pain Syndrome. International journal of environmental research and public health, 19(8), 4675. https://doi.org/10.3390/ijerph19084675

Pal, S., Choi, J. H., Delp, S. L., & Fredericson, M. (2023). Botulinum neurotoxin type A improves vasti muscle balance, patellar tracking, and pain in patients with chronic patellofemoral pain. Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 41(5), 962–972. https://doi.org/10.1002/jor.25435

Priore, L. B. D., Perez, V. O., Briani, R. V., Farinelli, L. A. L. B., da Silva, J. C. P., Martins, O. M. G., Lopes, F. A., Amorim, A. B., Pappas, E., & de Azevedo, F. M. (2023). Effects of an online program including mindfulness, exercise therapy and patient education compared to online exercise therapy and patient education for people with Patellofemoral Pain: protocol for a randomized clinical trial. BMC musculoskeletal disorders, 24(1), 372. https://doi.org/10.1186/s12891-023-06491-x

Rathleff, M., Hansen, R., & Holden, S. (2023, August 2). Patellofemoral Pain (PFP). International Association for the Study of Pain (IASP). https://www.iasp-pain.org/resources/fact-sheets/patellofemoral-pain-pfp/ 

Rethman, K. K., Mansfield, C., Moeller, J., De Oliveira Silva, D., Stephens, J. A., Di Stasi, S., & Briggs, M. (2023). Kinesiophobia Is Associated with Poor Function and Modifiable through Interventions in People with Patellofemoral Pain: A Systematic Review with Individual Participant Data Correlation Meta-Analysis. Physical therapy, pzad074. Advance online publication. https://doi.org/10.1093/ptj/pzad074

Sannasi, R., Rajashekar, A., & Hegde, N. S. (2023). Association of patellofemoral pain syndrome (PFPS) with quadratus lumborum and lower limb muscle tightness a cross-sectional study. Journal of orthopaedics, 42, 1–5. https://doi.org/10.1016/j.jor.2023.06.007

Yoon, S. W., & Son, H. H. (2023). Effects of McConnell and Kinesio taping on kinematic variables during stair descent in patients with patellofemoral pain syndrome. Journal of back and musculoskeletal rehabilitation, 10.3233/BMR-220244. Advance online publication. https://doi.org/10.3233/BMR-220244