Overview
Patellofemoral Pain (‘Runner’s Knee’) is a common knee complaint with an annual prevalence of 23% in adults and 29% in adolescents across the general population (Collins et al., 2018). Critically, it does not appear to be a ‘self-limiting’ condition, meaning that it does not simply resolve over time without appropriate management. Rather, over half (55%) of those with the condition may present with unfavorable outcomes after three months of having patellofemoral pain (Collins et al., 2013).
There is also preliminary evidence to suggest that patellofemoral pain may be a precursor to osteoarthritis of the patellofemoral joint, highlighting its long-term impact (Thomas et al., 2010).
These statistics reflect a considerable burden on both individuals and the healthcare system, often leading to reduced participation in daily endeavors, occupational tasks and physical activity. Unsurprisingly, this can be particularly consequential for a person’s quality of life. It also highlights the importance of early identification and treatment of patellofemoral pain, which the remainder of this blog explores in detail.
Cause/s
Patellofemoral pain typically develops gradually over time, and there are several well-defined risk factors for it arising (Gaitonde et al., 2019), including:
- Loading of the patellofemoral joint through activities such as running, squatting and climbing up/downstairs
- Patella instability (due to prior injury or muscle imbalances)
- Reduced hip external rotator (outward rotation) strength
- Reduced quadriceps strength
- Foot abnormalities such as pes planus (flat foot)
Diagnosis & Symptoms
A diagnosis of patellofemoral pain is typically made based on the history of your symptoms and the physical examination performed by your physiotherapist. Common symptoms include (van der Heijden et al., 2015):
- Pain around or behind the patella
- Pain when the knee is bent during weightbearing activities, such as squatting or running
- Difficulty tolerating prolonged sitting due to pain and/or stiffness
- Less commonly, buckling of the knee due to pain and/or weakness
You can expect your physiotherapist to assess you for the risk factors listed above as part of the physical examination. Functional tasks or movement relevant to your goals should also be considered.
Imaging/Investigations
Imaging is not essential for you to be diagnosed with patellofemoral pain. The reason for this is that scans can show changes to the knee that may be suggestive of patellofemoral pain, but it is also possible for people with unremarkable imaging to suffer from this condition (Kasitinon et al., 2021). This lack of specificity reduces its diagnostic value, however there may still be instances where your treating physiotherapist suggests it. Typically, this would be to rule out other conditions causing pain, particularly in cases where it would change the recommended treatment plan.
Treatment
Given the range of factors that may lead to patellofemoral pain, a targeted and individualised management plan is necessary for an optimal recovery. Depending on your age, goals and physical function you may be recommended the following (Gaitonde et al., 2019):
- Exercise therapy, often with a combination of hip and knee-focused strength, proprioception and/or mobility tasks
- Manual therapy techniques
- Soft tissue mobilisation techniques (i.e. massage)
- Patellar taping or bracing
- Foot orthoses
- Gait retraining
Exercise is the cornerstone of patellofemoral pain management, providing the greatest improvements in pain and function in the short, medium and long term (Collins et al., 2018). Other interventions may be used to facilitate short- and medium-term outcomes, though are not recommended to be used in isolation.
Recommendations
As with any health concern, it is essential that your treatment plan is as individualised and targeted. This requires a comprehensive assessment and subsequent recommendations from a physiotherapist. If you think you may have patellofemoral pain, or you are concerned about your risk of developing it, contact us today to arrange a thorough appraisal by one of our therapists.
References:
- Collins NJ, Barton CJ, van Middelkoop M, et al2018 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, 2017British Journal of Sports Medicine 2018;52:1170-1178.
- Collins NJ, Bierma-Zeinstra SMA, Crossley KM, et al. Prognostic factors for patellofemoral pain: a multicentre observational analysisBritish Journal of Sports Medicine 2013;47:227-233.
- Thomas MJ, Wood L, Selfe J, et al. Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review. BMC Musculoskelet Disord 2010;11:201.
- Gaitonde DY, Ericksen A, Robbins RC. Patellofemoral Pain Syndrome. Am Fam Physician. 2019 Jan 15;99(2):88-94. PMID: 30633480.
- van der Heijden RA, Lankhorst NE, van Linschoten R, Bierma-Zeinstra SM, van Middelkoop M. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2015 Jan 20;1(1):CD010387. doi: 10.1002/14651858.CD010387.pub2. PMID: 25603546; PMCID: PMC10898323.
- Kasitinon D, Li WX, Wang EXS, Fredericson M. Physical Examination and Patellofemoral Pain Syndrome: an Updated Review. Curr Rev Musculoskelet Med. 2021 Dec;14(6):406-412. doi: 10.1007/s12178-021-09730-7. Epub 2021 Oct 29. PMID: 34713383; PMCID: PMC8733121.