Patellofemoral pain (PFP)
Patellofemoral pain (PFP) is a condition that is characterised by pain or discomfort that occurs around or beneath the patella (kneecap) (1). PFP most commonly presents in teenage years or in young adulthood but can occur in the population at any age (2).
Symptoms are usually associated with one or more of the following activities involving weight-bearing activities with a flexed (bent) knee:
- Stair climbing
- prolonged sitting and kneeling (1).
Patients may also describe clicking, aching or slight swelling around the knee (3).
Although there is no established association between gender and the prevalence of PFP, females tend to have an increased incidence of PFP compared with males (4,5). PFP is a well-known cause of anterior knee pain, however the aetiology and risk factors associated with PFP are still relativley unknown (6,7).
There is clear consensus that PFP is multifactorial in nature (1). Scientific research exists to propose relationship between PFP and patellar alignment and mechanics, foot mechanics, and hip strength and mechanics (6).
PFP can have a negative effect on an individual’s quality of life (8). Lankhorst et al (8) found more than half of symptomatic individuals can report a disappointing recovery 5-6 years after symptom onset. These self-reported outcomes are still present even in the absence of radiographic knee OA.
How can physiotherapy help?
Evidence supports the use of exercise therapy, particularly to that of the knee and hip to help treat PFP symptoms. Improving the mobility and strength of the lower limb may improve pain or function in symptomatic individuals (9).
Physiotherapists utilise their knowledge to design an individually tailored programme for someone experiencing symptoms of PFP (10). Within treatment sessions physiotherapists can use adjuncts as part of a combined approach such as dry needling, massage, kinesiology taping and joint mobilisation. Such techniques can help to optimise pain relieve in the short term and optimise function (10).
Try the below exercises to help build strength and improve knee mobility. Alternatively, book in for a physiotherapy assessment to see how we can support you today!
- Foam rolling the quads – complete 5-10 minutes approximately 2-3 x per week.
- Exercises 2,3 and 4. Complete 3 sets of 5-10 repetitions. This can be done 3-4 x weekly.
- Davis IS, Powers CM. Patellofemoral pain syndrome: proximal, distal, and local factors, an international retreat, April 30-May 2, 2009, Fells Point, Baltimore, MD. J Orthop Sports Phys Ther [Internet]. 2010 [cited 2023 May 20];40(3):A1-48. Available from: https://www.jospt.org/doi/10.2519/jospt.2010.0302
- National Institute for Health and Care Excellence. Knee pain – assessment: Non-traumatic causes [Internet]. 2022 [cited 2023 May 15]. Available from: https://cks.nice.org.uk/topics/knee-pain-assessment/diagnosis/non-traumatic-causes/
- Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, et al. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med [Internet]. 2016 [cited 2023 May 17];50(14):839–43. Available from: https://bjsm.bmj.com/content/50/14/839
- Smith BE, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F, et al. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PLoS One [Internet]. 2018 [cited 2013 May 20];13(1):e0190892. Available from: http://dx.doi.org/10.1371/journal.pone.0190892
- Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome: Epidemiology of patellofemoral pain. Scand J Med Sci Sports [Internet]. 2010 [cited 2023 May 20];20(5):725–30. Available from: http://dx.doi.org/10.1111/j.1600-0838.2009.00996.x
- Heino Brechter J, Powers CM. Patellofemoral stress during walking in persons with and without patellofemoral pain. Med Sci Sports Exerc [Internet]. 2002 [cited 2023 May 20];34(10):1582–93. Available from: http://dx.doi.org/10.1097/00005768-200210000-00009
- Willy RW, Hoglund LT, Barton CJ, Bolgla LA, Scalzitti DA, Logerstedt DS, et al. Patellofemoral pain: Clinical practice guidelines linked to the international classification of functioning, disability and health from the academy of orthopaedic physical therapy of the American physical therapy association. J Orthop Sports Phys Ther [Internet]. 2019 [cited 2023 May 20];49(9):CPG1–95. Available from: http://dx.doi.org/10.2519/jospt.2019.0302
- Lankhorst NE, van Middelkoop M, Crossley KM, Bierma-Zeinstra SMA, Oei EHG, Vicenzino B, et al. Factors that predict a poor outcome 5-8 years after the diagnosis of patellofemoral pain: a multicentre observational analysis. Br J Sports Med [Internet]. 2016 [cited 2023 May 17];50(14):881–6. Available from: https://pubmed.ncbi.nlm.nih.gov/26463119/
- Collins NJ, Barton CJ, van Middelkoop M, Callaghan MJ, Rathleff MS, Vicenzino BT, et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med [Internet]. 2018;52(18):1170–8. Available from: https://bjsm.bmj.com/content/bjsports/52/18/1170.full.pdf
- Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. The “Best Practice Guide to Conservative Management of Patellofemoral Pain”: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med [Internet]. 2015 [cited 2023 Aug 3];49(14):923–34. Available from: https://bjsm.bmj.com/content/49/14/923.long