Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is common in the young, active population. Pain is behind or around the kneecap primarily with squatting, stairs, running, jumping and prolonged sitting. Other knee conditions, such as patellar tendinopathy, must be ruled out as pain with exercise is more conservative with PFPS compared to the more aggressive pain-monitoring model with tendinopathy.

It is helpful to determine the impairments that lead to each patient's pain complaint to develop an individualized program as it may need to address training errors and/or strength, mobility or neuromuscular control deficits.

Strengthening should include both hip and knee-focused training with open and closed kinetic chain exercises. Foot/ankle strengthening and orthotics may be beneficial if midfoot collapse causes compensations at the knee. Exercises should focus on progressive overload while maintaining proper form and neuromuscular control, especially in the frontal plane, to avoid knee valgus which places undue strain on the joint. Blood flow restriction training should be used in those who cannot strength train without excessive anterior knee pain.

Stretching/mobility work should target hip flexors, quads, IT band, hamstring and calf. Patellar taping may assist in pain reduction. The usefulness may be determined with the step down test assessing pain, range and repetitions pre and post taping. Gait retraining may include cues such as soft, quiet landing and increasing cadence which both reduce peak impact forces upon landing. Running education may also include volume of running and avoiding hilly areas. PFPS may persist if not treated appropriately so education is important on the importance of therapy to address impairments and gradually return to pain-free activity.