Patellofemoral knee pain – identification and treatment

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What is Patellofemoral knee pain (PFP)?


Patellofemoral pain (PFP) is a common umbrella diagnosis for pain occurring in the patellofemoral joint or surrounding areas such as retro patellar knee pain, with annual prevalence for PFP around 23% (2). Typically, it has a non-traumatic origin and gradual onset with poor diagnostic imaging success, so patient history and assessment is important to identifying PFP (1). Symptoms usually arise during knee flexion activities and movements such as running, squats and stair descent and symptoms are usually progressive. There is strong evidence that sex, height, weight, BMI, Age, and knee valgus angle are not correlated to PFP which have all been previously stipulated as risk factors contributing to PFP onset (1). So, what can we do and how can we manage this condition?

How is Patellofemoral knee pain treated?


Current research suggests that primary treatment should be progressive knee and hip strengthening exercise therapy as it has been shown to be the most effective method to improve PFP, with a combination of knee and hip outperforming either joint isolated (2). This progressive exercise therapy should be individually tailored to address specific deficits present and targeted towards achieving the patients’ goals (2). Including core strengthening, education and progressive aerobic exercise are also central to the successful management of PFP for long term success. When beginning treatment, short term changes and reductions in knee loading is essential to facilitate the recovery process. See our ‘Knees over toes’ blog for information on managing knee loading during training and exercise modification tips.

Complimentary treatments for PFP can include patellofemoral taping, gait retraining and orthoses (2). These have moderate evidence for short term improvements in symptoms but should always be complimentary to knee and hip strengthening exercise therapy.

The main goals for treatment should be to improve the load capacity of both the knee and hip joints, to manage loads placed through these joints during common movements such as running. Complementary treatments will modify either sensory input or short-term loading, although will not act to increase joint capacity. Hence, they can be useful for short-term improvements in symptoms, but not the focus of treatment and aimed to be tapered off.

Historically, patient outcomes are quite poor for PFP treatment, with around half of patients reporting unfavourable recovery at 5-8 years post treatment (3). This highlights the need for the highest-level of evidence-based treatment and early intervention patients suffering from PFP.


Need more help? 

If you need assistance in managing PFP or advice on the best evidence-based treatment, make sure you book in to see an Accredited Exercise Physiologist or Physiotherapist to take control of your rehab!

Read more blogs about knee pain written by EP, Josh Bonney:

What to do when your knee replacement has been pushed back

Knees over toes: Fact or myth? 

 

References:

  1. https://bjsm.bmj.com/content/53/5/270
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693858/
  3. https://bjsm.bmj.com/content/50/14/881

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