Patellofemoral Knee Pain Treatments - Pursuit Physical Therapy
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PATELLOFEMORLA KNEE PAIN

Are you not able to continue your cherished hobbies or everyday activities because of sharp pain in your knee when you move? With our expert doctors’ help, you can get to the root of your symptoms and get back to doing what you love quicker and easier.

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Best Orlando Treatment for a

PATELLOFEMORLA KNEE PAIN

Are you not able to continue your cherished hobbies or everyday activities because of sharp pain in your knee when you move? With our expert doctors’ help, you can get to the root of your symptoms and get back to doing what you love quicker and easier.

Read More Ask A Question

Here Is Everything You Need To Know About Patellofemoral Knee Pain, What Causes It, and The Best Way to Treat It

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What is patellofemorla knee pain?

Patellofemoral pain syndrome (PFPS) is 1 of the most common types of knee pain, particularly among athletes, active teenagers, older adults, and people who do physical labor. Patellofemoral pain affects more women than men and accounts for 20%-25% of all reported knee pain.

What are common causes of patellofemorla knee pain?

Patellofemoral pain syndrome refers to pain at the front of the knee, in and around the kneecap. (The kneecap, or patella, is the triangle-shaped bone at the front of the knee joint. The pain usually is accompanied by tenderness along the edges of the patella.Current research indicates that PFPS is an “overuse syndrome,” which means that it may result from repetitive or excessive use of the knee. Other contributing causes may include:
  • Weakness, tightness, or stiffness in the muscles around the knee
  • An abnormality in the way the lower leg lines up with the hip, knee, and foot
These conditions can interfere with the ability of the patella to glide smoothly on the femur (the bone that connects the knee to the thigh) during movement. The friction between the under-surface of the patella and the femur causes the pain and irritation commonly seen in PFPS. PFPS often occurs in people who are physically active or who have suddenly increased their level of activity, especially when that activity involves repeated knee motion, running, stair climbing, squatting, or repeated carrying of heavy loads. If you are older, you might have age-related changes that cause the cartilage on the under-surface of the patella to wear out. The result is pain and difficulty completing even the simplest daily tasks without pain. Usually, patellofemoral pain is worse when you walk up or down hills or stairs and on uneven surfaces. This pain tends to increase with activity and improve with rest. You also may:
  • Feel pain after sitting for long periods of time with the knee bent
  • Occasionally hear or feel a “cracking” or “popping” when you bend or straighten your knee

Where does it hurt?

In most cases of patellofemoral knee pain, people complain of pain right in the front of the knee on the patella or kneecap. In some cases, the pain will be right at the bottom of the kneecap, or right on the shin where the patellar tendon attaches. There are many different causes of anterior knee pain and even your low back can cause anterior knee pain. Because of this, it’s possible to feel the pain in other parts of your body. This is called referred pain. Understanding the root cause of your pain is fundamental to treating your pain in the long run & will decrease your dependence on painkillers or treatment that only addresses the symptoms.

What are common symptoms of patellofemoral knee pain?

 
  • Anterior knee pain
  • Kneecap pain
  • Pain going up and down stairs
  • Increased pain with squatting and running
  • A deep ache in front of the knee and patellar tendon

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To Get A Insider's Look
  • Learn The Essential First Step... So You Can Get Pain Free Again
  • See Why Treatment Needs To Be Individualized, Not Standardized...So You Get Faster Results!
  • Learn How You Can Save Money...So You Don't Have To Waste $1000's On Unnecessary Treatments

To Get A "Insider's Look" At Our Treatment Approach And How We Get Results...

Click Below To Watch Our Exclusive Webinar!  It's Simple, Short, And It's Free!

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To Get A Insider's Look
  • Learn The Essential First Step...So You Can Get Pain Free Again
  • See Why Treatment Needs To Be Individualized, Not Standardized...So You Get Faster Results
  • Learn How You Can Save Money...So You Don't Have To Waste $1000's On Unnecessary Treatments

Can patellofemoral knee pain be treated?

Yes, patellofemoral knee pain can be treated and with great results. Even better, many times it can be treated conservatively without needing injections, pain medications, or surgeries if you can address it early enough. The key to treatment is to solve the root cause of your pain so you can get the best results and a long-term outcome. Some root causes of patellofemoral pain can be:
  • Decreased hip range of motion
  • Poor posture in sitting causing hip tightness
  • Hip arthritis and labral tear
  • Weak hip and glute muscles
  • Poor patella tracking
  • Poor lifting and running biomechanics
  • Hip flexor problems
  • Leg length discrepancy
  • Previous leg or hip injury
  • Tight low back and hip joints
  • Poor biomechanics with sports
  • Trigger points in hip and thigh muscles
  • Lack of ankle range of motion
If you have failed multiple treatment approaches already, your clinician missed the real root cause of your pain and was just chasing the symptoms. The pain or symptom is the effect, not the cause. What do I mean by this? Say your fire alarm goes off in your house. Its purpose is to protect you and make you aware that something is wrong, i.e., that there is a fire in your house. The “alarm” is like your pain (your body’s way of telling you something is wrong) and the “fire” is the root cause. When the fire alarm goes off, you don’t run upstairs and just turn it off, right? You run through the house with the fire extinguisher, trying to find the room where the fire is at. You try to find out what caused the alarm to go off so you can put it out. Once the fire is out, then the fire alarm can go off. Solve the “root” cause of your pain, and then the pain (“the effect”) eventually goes away. Additionally, there is a common root cause which many clinicians misdiagnose. They treat the knee pain with a cookie cutter approach, hoping it will work and treat it as a simple muscle problem. They tend to rely on stretching, ultrasound, massage and focus treatment directly on the knee joint. However, often the root cause is missed and the symptoms return. If you have failed multiple treatments and still have knee pain, then maybe it’s not just a knee problem? There is probably something else adjacent to the knee, like the hip or ankle, that is overloading or stressing the knee to cause your pain.  Other neighboring joints can influence your primary complaint area causing your pain. So many healthcare clinicians treat pain like this and thus show poor treatment outcomes which results in the pain coming back. Why? They missed the root cause of your knee pain. This is also the case when patients turn to injections, nerve blocks and other surgeries which are still not effective because the actual problem still is not solved, their treatment was just chasing the pain. The first step in treatment is to identify the root cause of your pain. A specific and individualized treatment approach for your type of pain can lead to a successful outcome for you and resolve your symptoms for the long term. This is why you can’t rely on a standard cookie cutter approach; you need a customized and individualized treatment approach specifically for your type of patellofemoral knee pain.
“I had been experiencing knee pain for months, which gradually got worse and worse. I’m normally very active in sports such as Crossfit, OCR training, and Brazilian jujitsu so this was really frustrating. After the first visit, I immediately started feeling relief. Two weeks later, I’m walking around without pain. I can’t wait to get back to squats and pistols!

What happens if it goes untreated?

Minor case – If it is a minor case of patellofemoral pain, research shows that many acute cases of pain may spontaneously go away in 4-8 weeks. The key to prevent from becoming a more severe chronic case is to solve the root cause of the knee pain and determine what actually is causing it. Many times, it’s not really a knee pain problem and the cause is somewhere else. But who wants to wait 8 weeks to get pain free? Let’s try to solve the root cause of your pain in 2-3 weeks and address all of the risk factors present (so it never returns!) and get you back to your favorite activities faster! We still recommend that you get it checked out by one of our board-certified physical therapists to ensure that it is just a minor case, to solve all risk factors, and to get the optimal outcome in the fewest visits needed. Most minor cases resolve on their own in time or get better with some stretching and strengthening. But, the sooner you take action, the sooner you are pain-free. (And research supports this!) Severe case – If it’s more of a severe and chronic case of patellofemoral pain, your pain will probably start to worsen and increase because the root cause and underlying risk factors of the pain are not being treated. Many people turn to pain medication and injections at this time but this only blocks the pain for short term. You may not feel the pain when taking pain medications, but the underlying problem is still there. Many people say after the pain medication and injection wears off, then usually the pain returns and sometimes it returns even worse. This is when you experience knee pain while sitting and pain walking up and down stairs. If the knee pain continues to worsen, you may start experiencing difficulty walking, be unable to run or golf, and you may get sharp knee pain. Once the root cause is addressed, then we can start decreasing your pain, regardless of how chronic and severe the pain is. This is the crucial first step. It just may take more time to recover from a chronic case. Usually with chronic and severe cases, the longer you have your pain and injury, the longer it takes to resolve.

What outcome can you expect from treatment?

As we’ve discussed, the first step is to solve the root cause of your patellofemoral knee pain. This is the most essential step to plan a treatment specialized for you and your unique type of pain. Your root cause will guide your treatment and dictate what is the best way to treat your pain. This, along with identifying risk factors that may be predisposing you to have your pain and injury, will allow you to start getting pain free again. The next step is to start decreasing pain, modifying activities, and start addressing all of the impairments causing your pain which we discovered during your evaluation. With each session, pain should start to decrease and you should start to regain range of motion with less pain and symptoms. Any radicular and referred pain should resolve fast as well. At this point, we begin light and basic strengthening only if it does not increase pain. Treatment will consist of a lot of manual therapy and light exercises. The next step is to achieve full range of motion, (which should correlate to being pain free) and now we can start progressive strengthening. Strengthening the muscles is crucial and research shows that this gives you the best long-term outcome! As you start to get stronger and maintain your mobility, your pain will continue to decrease if it is not already gone. Your increased strength will allow you to perform more activities and prevent flare ups. This usually does take up to 4 weeks. As you clear our goals, then we can start easing you back into sport, golf, running, and whatever your favorite activities are. This is when we start winding down treatments and getting you back into functional strengthening, sport specific training, return to run programs, golfing, and whatever your goals are. At the end, we reassess everything, making sure we achieved all of our goals, your goals, that all risk factors are gone, and finalize your long-term home exercise program. There are many factors which can influence your outcome, but 85-90% of our patients respond well to our treatment approach and achieve a successful outcome when completing their plan of care.

To Get A "Insider's Look" At Our Treatment Approach And How We Get Results...

Click Below To Watch Our Exclusive Webinar! It's Simple, Short, and It's Free!

Yes! I Want Access To The Free Webinar

To Get A Insider's Look
  • Learn The Essential First Step... So You Can Get Pain Free Again
  • See Why Treatment Needs To Be Individualized, Not Standardized...So You Get Faster Results!
  • Learn How You Can Save Money...So You Don't Have To Waste $1000's On Unnecessary Treatments

To Get A "Insider's Look" At Our Treatment Approach And How We Get Results...

Click Below To Watch Our Exclusive Webinar!  It's Simple, Short, And It's Free!

Yes! I Want Access To The Free Webinar

To Get A Insider's Look
  • Learn The Essential First Step...So You Can Get Pain Free Again
  • See Why Treatment Needs To Be Individualized, Not Standardized...So You Get Faster Results
  • Learn How You Can Save Money...So You Don't Have To Waste $1000's On Unnecessary Treatments

How is it diagnosed?

When you seek help for patellofemoral pain, we will perform a comprehensive evaluation and ask questions about your pain and your daily activities. These may include:
  • How and when the pain started: Did the pain begin spontaneously or was there any trauma or injury experienced in the area?
  • Where are the symptoms located, and have they changed location or intensity since the onset?
  • What things make the symptoms better or worse?
  • What type of work do you perform?
  • What hobbies or household activities do you regularly perform?
  • What is the worst your pain gets throughout the day?
  • What activities throughout your day make your pain worse?
One of our board-certified physical therapists will perform a thorough assessment of your evaluation, testing: movement, a range of motion, joint mobility, strength, muscle activation, nerves, and functional movement. The therapist will also check your reflexes, do a medical screening (to rule out medical red flags and serious pathologies), and conduct special tests on your primary area of pain to determine what specifically may be involved and to rule out other conditions. The key to getting an accurate and correct diagnosis is the reproduction of your pain during the evaluation. We want to find out if we change (or even decrease) your pain during the evaluation. This is the key! To provide a definitive diagnosis, your therapist may also collaborate with an orthopedist or other healthcare providers. The orthopedist may order further tests, such as magnetic resonance imaging (MRI) or electromyography (EMG) if medical red flags are present. After the evaluation, you will know exactly what your diagnosis is and what exactly is causing your pain. You will have plenty of time to ask questions to ensure that you fully understand what is going on. The next step, then, is to determine what is the best way to treat it.

Do you need an X-ray and MRI imaging for patellofemoral pain?

For most common orthopedic cases, imaging is not needed and the diagnosis can be made with a simple physical therapy evaluation. No need to waste thousands of dollars on unwarranted diagnostic imaging. We also have clinical tests which we can perform to help rule in and rule out pathologies that correlate to MRI findings (which is WAY cheaper than an MRI!). An expensive MRI may just tell us what we already know. Also, often times the positive findings found on x-rays, MRIs, and EMGs may not actually be the root cause of your pain. What does that mean? Many positive findings on an MRI are also found in asymptomatic (pain-free) individuals, so diagnostic imaging may not be able to tell us what is actually causing your pain. For example: many people have a herniated disc in their low back but do not have any low back pain. So if herniated discs can cause no pain, just because someone with low back pain has a herniated disc does not mean that is what’s causing their pain. The key is to find out if your clinical evaluation findings during your evaluation at Pursuit match the MRI findings. If so, then we can decide what is the best way to treat it.

How can a Physical Therapist treat it?

After a comprehensive evaluation, your therapist will analyze the findings and prescribe an exercise and rehabilitation program just for you. Your program may include:
  • Strengthening exercises targeted at the hip (specifically the abductor and rotator muscles of the buttock and thigh), the knee (specifically the quadriceps femoris muscle, which is located on the front of your thigh and straightens your knee), and the ankle
  • Stretching exercises for the muscles of the hip, knee, and ankle
  • Taping of the patella to reduce pain and retrain muscles to work efficiently
  • Exercises for improving your performance of activities that have become difficult for you
If the alignment and position of your foot and arch appear to be contributing to your knee pain, your physical therapist may fit you with a special shoe insert called an orthosis. The orthosis can decrease the stress to your knee caused by excessive rotation or impact during walking and running. If your pain is persistent, your physical therapist may:
  • Have you try a lightweight brace
  • Use pain-reducing treatments such as electrical stimulation
  • Recommend that you apply ice or heat at home for relief
Your physical therapist will work with you to help you stay active and maintain your fitness level. You may need to modify your activity level or change your training activities until you recover; your therapist will show you how to do activities and exercises that will not increase your pain. Most important, your therapist can make recommendations to help prevent PFPS from returning.
“After at least three years of doctor-hopping […] looking for someone to alleviate my constant dizziness and neck pain, I finally found Dr. Miller. I have more energy and less pain, and have halved my dependence on painkillers. He shouldn’t be the last stop on your road to recovery, he should be the first.”

How long does it take for recovery?

Recovery time for patellofemoral pain depends on multiple factors:
  • The severity and chronicity of your pain
  • Whether your pain is an easy or complex case
  • If the root cause of your pain was solved or if it was missed (this is the key to getting a great recovery!)
  • How long you have been in pain for and when you need to be pain-free by
  • Other therapies and treatments you have tried
  • Which medical professional(s) you saw prior to seeing us
  • How active you are in trying to resolve your pain
  • Which treatment approach is chosen and if it is proven to work for your pain
There are many factors that influence your recovery time and every patient’s recovery time is different. If you do nothing and don’t pursue treatment, it could gradually get better on its own, you could continue to have the same pain persist, or it could continue to get worse. As stated earlier, most acute cases may or may not resolve in 4-8 weeks. If you get expert treatment that solves the root cause of your pain, some cases resolve in 1-3 weeks! Then you can get back to sports, exercise, and your favorite activities without flare-ups and recurrences. Some of our patients are pain-free in 1-3 visits and back to 100% in 2 weeks! If it is a complex case with chronic pain, your recovery may take longer, but you can still get a good outcome. Some chronic cases can resolve as fast as 2 months but can take as long as 4-6 months. It varies with every patient because every case of patellofemoral pain is different. Every patient’s recovery varies depending on the factors listed above. After a thorough evaluation here at Pursuit Physical Therapy, you will know your exact timeline of recovery, your prognosis, and when you should reach your goals.

How much does it cost?

The average cost of care for a case of spine pain in the US is $1800-$6600. This high price is due to many factors: the over-inflated cost of healthcare, the over expensive cost of unwarranted imaging (x-rays, CT scans, and MRIs) that is not needed, over-utilization of care (which increases the number of visits needed to be treated, requiring multiple visits to different doctors and physical therapists for the same diagnosis), and getting billed for unnecessary and unproven treatments that you don’t even need. All of these factors increase cost and this is why healthcare is so expensive. We strive to end that unnecessary, expensive cycle. In fact, we are currently publishing our first-year data with the University of Central Florida that shows the cost-effectiveness of our treatment approach. This year, the average cost of our care was shown to be $814-$1141. Some of our patients get even as low as $315 for the full treatment! So if you have a deductible of $3,000-$10,000 and you have to pay out of pocket for your treatment, we can save you lots of money. Remember, every case of pain is different and not all patellofemoral pain is the same. It is hard to predict exactly how much your treatment is going to cost you. But after a thorough evaluation, we can tell you exactly what is causing your pain, how long it is going to take, what the best way to treat it will be, and exactly how much it is going to cost. We have no hidden fees, no co-pays, and no miscellaneous bills that you will be surprised by 3 months after you receive treatment. Your pain, your diagnosis, your goals, and what is best for you dictate your treatment and how much it will cost, and while it varies for every patient, treatment at Pursuit is still much more affordable than standard healthcare.

How long are sessions?

Our evaluations are always one-on-one with one of our board-certified specialists and 60-90 minutes long. We like to perform thorough evaluations so we can solve the root cause of your pain, identify all risk factors, and make sure that we do it right. After the evaluation, you will know your diagnosis, the root cause of why you have your pain and symptoms, your prognosis, an expected timeline of when you should see results, what the best way to treat your pain is, how much it will cost, and your expected recovery outcome. We want you to fully understand everything about your pain and injury. What is best for you and will get you the best outcome is what will dictate your care and treatment. There will be plenty of time for you to ask questions so we can make sure you fully understand why you have your pain and what the best way to treat it will be. After the evaluation is completed, all treatment sessions are 60 minutes going forward and still one-on-one with your physical therapist. You and your physical therapist will design a customized treatment plan that works for you and that will achieve your goals.

How can it be prevented?

PFPS is much easier to treat if it is caught early. Report the first signs of knee pain to your physical therapist. Early treatment by a physical therapist may help stop the underlying problem before it gets worse. Your physical therapist also can help you adjust your daily activities and teach you exercises to do at home to strengthen your muscles and bones and help prevent PFPS from recurring.

What are next steps?

Getting started is simple. The first step, and the key to getting you pain free again, is to solve the root cause or your case of pain. Remember, not all pain is the same. Your pain is different than someone else’s pain, even though it may be in the same area. If you’re ready to get pain free, give us a call at (407) 494-8835 or fill out the form below. The next step is to schedule your evaluation so we can solve the root cause for you. We’re happy to answer any questions you may have and we would love the opportunity to help you.

Solve the root cause of your pain

How Our Treatment is Different

We believe that working with a specific specialist for your care is the best way to solve the root cause of your pain. Work one-on-one with a Doctor of Physical Therapy every time your visit our office.

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Exclusive one-on-one patient care

While most clinics will give you a limited amount of time with your Doctor, we believe that true results come from consistent one-on-one therapy.

Work with your specialist every visit

Stop being handed off to trainees or non-Doctors for your Physical Therapy. At Pursuit, you'll work exclusively with your Doctor of Physical Therapy that specializes in your specific needs.

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Ever have an issue or questions? We're here to help. Get 24/7 access to your specialist while you're under our care. Physical Therapy doesn't just happen when you're in our clinic, so we're here for you when you need us.

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Get off that waiting list and get the treatment you need. We're always ready to accept new patients, so you can get better faster and get back to a pain-free life that you deserve.

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Don't let the insurance companies tell you how much treatment you need. Avoid the limitations of short sessions that insurance provides and work with our Doctors when you need it and for as long as you need it.

No painful injections, no expensive medications, no surgery

In order to truly solve your pain, we use a holistic approach to Physical Therapy, not relying on injections, medications, or surgery. Instead, we'll strengthen your body's weak points that are causing your pain.

MEET THE TEAM

Ron Miller

RON MILLER, DPT, OCS, Cert DN


Doctor of Physical Therapy | Board Certified Orthopaedic Physical Therapy Clinical Specialist | Post-Doctoral Orthopaedic Residency Trained | Certified in Dry Needling | Titleist Performance Institute Certified

Dr. Ron Miller is the owner and founder of Pursuit Physical Therapy. His core belief is that it is not about the physician, the physical therapist, or the insurance company: it is about what is truly best for the patient. Dr. Miller started...

Carey Rothschild

CAREY ROTHSCHILD, DPT, OCS, SCS, CSCS, CKTP


Doctor of Physical Therapy and Assistant Professor at the University of Central Florida | Board Certified Orthopaedic Clinical Specialist
| Board Certified Sport Clinical Specialist

Dr. Carey Rothschild is an Assistant Clinical Professor in the Doctor of Physical Therapy Program at the University of Central Florida.  Dr. Rothschild earned a Bachelor of Health Science in Physical Therapy in 1999 from the University of Florida and a Doctor of Physical Therapy from Boston University in 2005...

Carey Rothschild
Michael Fabrick

MICHAEL FABRICK, DPT, Cert. DN


Doctor of Physical Therapy | Certified in Dry Needling | Pursuit Sports Performance Specialist | Professional Tennis Tour Physical Therapist

Dr. Michael Fabrick was born and raised in Hanover, Pennsylvania and attended Slippery Rock University where he received his Bachelor’s degree in Exercise Science. He then went on to receive his Doctorate Degree in Physical Therapy in May of 2020. During his final tenure as a Doctoral intern, he trained underneath Todd Ellenbecker, who is one of the world’s leading experts on shoulder rehabilitation and is the Vice President of Medical Services for the ATP World Tour...

MARYANN DANIELS, PT, MCMT, IDN


Physical Therapist | Dry Needling Certified | Mastery Certified In Manual Therapy | Pelvic Floor And Post Partum Specialist

Maryann was originally born in Connecticut but moved to Florida with her family at the age of 9 and she grew up in Jupiter, Florida. She then went to college at the University of Central Florida...

Kayla Cook, DPT, HSP, CSCS


Doctor of Physical Therapy | Hesch Sacroiliac Practitioner | Certified Strength And Conditioning Specialist | Ehlers-Danlos Syndrome Specialist | Volleyball Specialist

Dr. Kayla Cook was born and raised in Northern California and received her undergraduate degree in Kinesiology from California State University in Sacramento.  She then received her Doctorate in Physical Therapy from The University of St Augustine for Health Sciences...

BECOMING PAINFREE  IS EASIER THAN YOU THINK

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Call our expert team.
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We’ll work with you to find and treat the root of your pain.
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