What is Patellofemoral Pain Syndrome (PFPS)?
Patellofemoral pain syndrome (PFPS) is a term used to describe pain in the front of the knee, often originating from behind the patella (kneecap).
While PFPS is common in people who are active, it also occurs in the non-athletic population. Like most overuse injuries, PFPS can come on suddenly or gradually over time, depending on a variety of factors.
PFPS is commonly caused by overuse or misalignment (or a combination of the two) of the patella. Vigorous physical activity (running, squatting, or lifting), repetitive stress (prolonged walking, kneeling, or climbing stairs) or a recent change in physical activity may bring on symptoms. Misalignment occurs when the patella does not track properly along the front of the knee joint. In a normal, healthy knee, the patella glides within a groove on the femur (thigh bone) as the knee flexes and extends. Misalignment can stem from excess pronation (arch collapse), which can cause the patella to move out of this groove, irritating the tissue and causing pain.
What do people experience?
While the most common symptom of PFPS is a dull, aching pain in the front of the knee that comes on gradually and gets worse with activity, you may also experience:
- Pain above the knee cap
- Pain after sitting for prolonged periods of time
- Pain while climbing stairs or rising from sitting
- Instability of the knee
- Crepitus (cracking or popping noise) in the knee
Risk factors & how to avoid discomfort
While overuse injuries like PFPS can affect a wide variety of people, there are several risk factors associated with developing symptoms of PFPS:
- Gender differences. Although the exact reason is not clearly defined, females are more prone to developing PFPS than males, according to several studies. Many clinicians attribute this to the variance in the Q-angle between males and females.
- IT band tightness/ITBS. Tension in the IT band can exert forces on the knee and knee cap that contribute to the mal tracking and increase pain. Reducing tension in the IT band can reduce this risk.
- Tightness or weakness in the quadriceps. The quadriceps work to stabilize the knee and allow it to function efficiently and smoothly. Weakness or tightness in the quadriceps decreases the stability and therefore allows for more motion of the knee cap, leading to mal tracking and symptoms of PFPS.
- Calf tightness. Tightness in the lower leg is also related to incidence of PFPS.
- Training. Volume, intensity, environment, and style of activity are all factors that can increase the risk for developing PFPS.
What are my options for treatment? Who else can help?
Just as there are many causes for PFPS, there are also many ways to manage the symptoms. Choosing which treatment is right for you will depend largely on the symptoms you experience, and when you experience them. Primary treatments have traditionally included local pain management via physiotherapy, nonsteroidal anti- inflammatory drugs (NSAIDs), rest, and cold therapy. Further interventions might include devices or braces to alter any abnormal biomechanics or increase joint efficiency.
Your primary care provider is the best initial resource for this injury. They will be able to recommend activity modifications or medications and refer you to the right professional for further care.
Physiotherapists and kinesiologists can help with strengthening, stretching, and alignment issues that impact your pain. They may also be able to recommend a brace or provide taping or other modalities to control pain and abnormal biomechanics. For those who are more active, a physiotherapist or kinesiologist may also be able to assist with activity modifications and training changes to help manage your pain while keeping up activity levels.
A pedorthist can help control excessive movements at the foot that impact the alignment and movement at the knee. Your pedorthist may recommend a custom orthotics or incorporate an orthotic device to correct these movements and realign the lower limb.
Physiotherapists can help with strengthening, stretching and alignment issues that impact your pain. They may also be able to recommend a brace, provide taping, or other modalities to control pain and abnormal biomechanics.
Massage therapists can assist in reducing muscular tension that may put stress on the knee. Common areas where a massage therapist can help are the IT band, hamstrings, and quadriceps tightness. In conjunction with stretching, treatment from your RMT may significantly improve your symptoms.
Kinesiologists can help you modify your activity or training to reduce your pain. These changes can help manage your pain while remaining active.
Staying active with pain
Remaining active with PFPS is possible with a few training, lifestyle, and activity modifications. As a general rule of thumb, if it hurts, don’t do it. Taking that golden rule a bit further, if it hurts after you finish your activity, reduce it by 10%.
Reducing volume and intensity of activity is often the simplest way to stay active through an injury. Reducing your volume gradually until the pain subsides, avoiding inclines and high impact activities, and alternating to non-weight bearing activities are all effective ways to stay active through your recovery.
Another option is to use over the counter solutions to help mitigate excess motion or strain through the knee. Using braces, compression sleeves, or taping can help you maintain your activity and keep from injuring yourself further. Talk to your kinesiologist or physiotherapist about which devices might be right for you.