Patellofemoral Pain Syndrome (PFPS)

What is it?

PFPS describes pain around the front of knee and around the knee cap. It is an umbrella term to define dysfunction in this area that can be caused by a wide variety of reasons. Signs and symptoms include knee pain associated with prolonged sitting, deep squatting, during stair/hill walking, jumping and running. Imaging is not required to diagnose PFPS.

What can YOU do about it?

Load modification:

Temporarily decrease running/jumping loads and modify sitting positions to sit higher with only a small bend in knees can reduce symptoms in the early stages of management.

Foam roll/massage ball/stretch:

Target the muscles of your thigh (front, back & side) and around the hip to reduce tension in these areas.

Foam rolling videos:

1. Foam roll vastus lateralis (outer quad)

2. Foam roll quadricep group

3. Foam roll outer hamstring (biceps femoris)

4. Foam roll guteus medius

5. Foam roll gluteus minimus (stay above the bony point on side of hip)

6. Massage ball to QL

   • How to find QL

     • standing upright, place hands on hips finding the border of you pelvic bones where your waist begins

     • where your thumb is at the back, move your thumb an inch higher

     • confirm you are on QL by hiking that hip up slightly, you should feel a muscle press into your thumb, this is your QL

7. Massage ball to TFL

   • How to find TFL:

     • standing upright find the bony point at the front of your hip and the bony point on side of hip

     • imagine a diagonal line between these two points, place your fingers in the centre of the line

     • confirm your on TFL by turning your foot & knee inwards you should feel a muscle press back into your fingers this is you TFL!

Stretching videos:

1. quad stretch & outer quad stretch if you have trouble with balancing, place your hand on wall or back of chair for support or do lying down on your tummy

2. lateral hip stretch

3. Lateral hamstring stretch

Strength & Conditioning:

Work on strengthening the muscles responsible for pelvis and knee stability to rehab PFPS using exercises such as single leg variations of sit-to-stands, squats, glute bridges; and RDLs. Individualised progressions of these exercise guided by our Clinical Myotherapists condition the knee to return to full function.

Here are some exercises we popularly use in the management of PFPS:

1. Terminal Knee Extension/VMO activation

2. Hip Shift off step (add KB around ankle for progression)

3. KB Marches

4. Single Leg Glute Bridge

   • progress to single leg hip thrust

5. Glute med bias RB split squat

   progress to Bulgarian Split Squat

6. Single leg sit-to-stand, starting high and lowering surface to make harder

   • progress to single leg TKX squat (again start high and progress depth where symptoms allow)

7. B-stance RDL

   • progress to SL RDL

As we are working to build strength you should be aiming for 3 -4 sets of 6-8 repetitions of each exercise, once this is feeling relatively easy you are ready for the next progression.

Taping:

There are a number of taping techniques that can reduce symptoms associated with PFPS, this diamond taping method is our personal favourite:

Diamond taping method for PFPS by Sandringham Sports Physio

What can WE do about it?

As Myotherapists treating PFPS, our main objective is to decrease pain and help restore optimal function of the patellofemoral joint.

• We use a number of manual therapy techniques and taping to reduce PFPS symptoms.

• We identify and address biomechanical factors that may have contributed to the development of PFPS.

• We provide guidance on load management, exercise rehabilitation and further symptom management strategies.

What Does the Research Say?

Recent systematic reviews & meta-analyses support a highly individualised and multimodal approach to the management of PFPS that highlights exercise therapy (in particular quadricep and hip strengthening) as the primary pillar of treatment. There are numerous factors that have been attributed to patellofemoral pain and thus a thorough assessment of each individual with exercises tailored to adress the biomechanical factors found is highly endorsed in academia. Adjunct therapies including manual therapy, orthotics, and taping are also well supported in the literature. There higher rates of co-existing anxiety, depression and chronic pain in populations experiencing patellofemoral pain, this means that a holistic approach to health whilst treating PFPS management should be undertaken.

References:

Xu et al (2024)

Shi et al (2024)

Veeresh et al (2024)

Yoon et al (2023)

The National Institute for Health & Care Excellence (NICE)

The American Physical Therapy Association (APTA)

Why see a Healthcare Practitioner?

Assessment

Other pathologies of the knee can be mistaken as PFPS it’s important to be assessed by a healthcare practitioner to ensure the correct management strategies are being undertaken to ensure your knee pain improves.

Individualised Treatment

PFPS is multifactorial, this means that an individualised approach to management is often required to ensure optimal recovery.

BOOK NOW with Peninsula Clinical Myotherapy and get on track to a pain-free knee today!