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Patellofemoral Pain Syndrome - Causes & Treatment

Patellofemoral pain syndrome causes pain around the kneecap, often due to overuse or malalignment. It is common in athletes and adolescents and is usually treated with physiotherapy.

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Things worth knowing about "Patellofemoral Pain Syndrome"

Patellofemoral pain syndrome causes pain around the kneecap, often due to overuse or malalignment. It is common in athletes and adolescents and is usually treated with physiotherapy.

What is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain, particularly in physically active individuals and adolescents. It refers to pain arising from the joint between the kneecap (patella) and the thigh bone (femur). The condition occurs when the kneecap does not glide smoothly along its groove on the femur, leading to increased pressure on the joint surface and surrounding soft tissues.

Causes

Patellofemoral pain syndrome is typically caused by a combination of factors:

Overuse: Repetitive activities such as running, cycling, or stair climbing can irritate the patellofemoral joint.
Muscle imbalances: Weakness or imbalance in the quadriceps muscle leads to poor patellar tracking.
Leg alignment issues: Knock-knees (valgus alignment) or abnormal tibial rotation can affect kneecap positioning.
Patellar malalignment: A laterally displaced or tilted patella increases cartilage pressure.
Tight muscles: Tight quadriceps, hamstrings, or calf muscles can alter knee biomechanics.
Sudden increases in training load: Rapid changes in training intensity or volume without adequate recovery.

Symptoms

The hallmark symptom is a dull, aching pain around or behind the kneecap. Common complaints include:

Pain when climbing or descending stairs (especially going down)
Pain after prolonged sitting with bent knees (the so-called "theater sign")
Discomfort when squatting, kneeling, or crouching
Pain during running or cycling
Occasional clicking or grinding in the knee
Increased pain after prolonged standing

Significant swelling of the joint is uncommon and should prompt further medical evaluation to rule out other conditions.

Diagnosis

Diagnosis is primarily clinical, based on a detailed medical history and physical examination. The examining clinician will assess:

Location and nature of pain
Leg alignment and patellar position
Quadriceps muscle strength and function
Specific provocation tests, such as the Clarke sign (pain on patellar compression during quadriceps contraction)

Imaging studies such as X-ray or MRI (magnetic resonance imaging) may be used to exclude other causes such as cartilage damage, meniscal injury, or bony abnormalities.

Treatment

Conservative Treatment

The vast majority of patients respond well to non-surgical treatment:

Physiotherapy: Targeted strengthening and stretching of the quadriceps muscle is the cornerstone of treatment. Special emphasis is placed on training the inner quadriceps component (vastus medialis obliquus).
Activity modification: Temporary reduction and adaptation of sporting activities to reduce joint stress.
Taping and bracing: Kinesio tape or patellar braces help stabilize the kneecap and reduce pain.
Orthotic insoles: Custom or prefabricated insoles can correct foot and leg alignment problems.
Pain relief medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be used for short-term pain relief.
Patient education: Guidance on low-impact activities and appropriate training adjustments.

Surgical Treatment

Surgery is rarely required and is only considered when conservative treatment has failed over an extended period and a clear structural abnormality has been identified. Possible procedures include realignment of the kneecap or treatment of cartilage damage.

Prognosis

With consistent treatment, the prognosis for patellofemoral pain syndrome is generally favorable. Many patients experience complete resolution of symptoms within weeks to months. Adherence to physiotherapy and appropriate modification of activity levels are key factors in recovery.

References

Crossley KM et al. - 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat. British Journal of Sports Medicine, 2016.
Petersen W et al. - Patellofemoral pain syndrome. Knee Surgery, Sports Traumatology, Arthroscopy, 2014.
Collins NJ et al. - Patellofemoral pain syndrome: current evidence for diagnosis and rehabilitation. Archives of Physical Medicine and Rehabilitation, 2012.

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