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 kne

How Is Patellofemoral Knee Pain Diagnosed?

Your physical therapist will review your health history, perform a thorough examination, and conduct a series of tests to evaluate the knee. Physical therapists use tests such as the patellar apprehension test, the Q-angle test, the patella alta test, and Clarke’s sign (patellar grind test) to determine whether the patellofemoral joint is the source of pain. In addition, your therapist may observe the alignment of your feet, analyze your walking and running patterns, and test the strength of your hip and thigh muscles to find out whether there is a weakness or imbalance that might be contributing to your pain. Finally, your therapist will check the flexibility of the muscles in your leg, paying close attention to those that attach at the knee. Generally, x-rays are not needed to diagnose PFPS.

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.

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.

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