Patellofemoral Pain Syndrome

Aetiology (What is it?)

Patellafemoral Pain Syndrome (PFPS), aka Runners knee is a common condition which affects the cartilage on the underside of the kneecap (patella) and the structures that support the patella.

Pathophysiology (What’s happening?)

PFPS occurs when the patella is not tracking correctly up and down the femoral groove during knee flexion and extension resulting in chronic stimulation of pain receptors in the knee. This mal-tracking may be due to a number of factors including overuse and overload of the patellofemoral joint, anatomical and biomechanical abnormalities and muscle weakness and imbalance.

The most common cause of PFPS is poor strength and flexibility in the hips, hamstrings and quadriceps. For example: a weak Vastus Medialis Oblique (VMO) may result in Vastus Lateralis causing lateral glide of the patella and therefore wear and tear of the tissues on the outside of the knee.

The other major cause is training errors, where mileage and or intensity are accelerated too quickly for the body to compensate. Pes planus (foot pronation), pes cavus (foot supination), and tight Iliotibial Band (ITB) are also implicated in PFPS.

Signs and Symptoms

- Tenderness at the front of or behind the kneecap

- Pain that is aggravated by downhill running or descending stairs

- Dull pain when running on uneven terrain

- pain when you push on the patella bone and with compressive forces such as sitting with knees bent, kneeling, and squatting.

Medical treatment options

In the acute stages it is important to see your Physiotherapist to obtain a diagnosis and rule out other conditions such as patella tendonitis, osteoarthritis, meniscus or cruciate ligament (ACL/PCL) tears. The physio may recommend a short period of rest and NSAIDs.

As inflammation decreases, movement is key. Research shows that strengthening the hip abductor muscles (especially gluteus medius) can reduce PFPS pain significantly. Think about exercises such as clam shells, and squat band with hip abduction. Also strengthening exercises for quadriceps will be important, especially Vastus Medialis Oblique (VMO).

Massage therapy is great in the sub-acute phase to improve hip flexibility by relieving tension in hip flexors and off-loading the knee joint by relieving tight muscles around the joint (quadriceps, hamstrings and calves).

Patella taping may be useful to offload the knee.

Prevention: Implementing a regular strength and flexibility routine is important to add to your running regime. Strengthening hips, glutes, quads and hamstrings improves overall stability thereby reducing load on the knee. Try not to increase mileage by more than 5-10% week by week. Keep muscles flexible by regularly using a foam roller – or better still, book in for a sports massage!