Patellofemoral Pain (PFP)
Patellofemoral pain is a common condition characterized by symptoms in and around the front of your knee, the bone called your patella, more commonly known as your kneecap.PLEASE NOTE: this is for informative purposes only and is not health advice and does not replace a consult with a health care provider. If you have specific medical conditions, are experiencing pain, or you’re just not sure where to start when it comes to exercise, please remember we’re here for you.
For more information, click on one of the topics below:
What is Patellofemoral Pain?
Patellofemoral pain is a common condition characterized by symptoms in and around the front of your knee, the bone called your patella, more commonly known as your kneecap.
These symptoms can be progressive, starting as tightness or discomfort and can become painful. Symptoms typically occur during activities that put stress though your knees, including high impact activities such as running and jumping, or low-load activities such as going up or down stairs, squatting, or simply prolonged sitting.
Who does Patellofemoral Pain affect?
Patellofemoral pain is especially common among physically active individuals, and usually comes on gradually, without a specific impact or trauma to the knee.
The exact cause of this condition is poorly understood, with many different theories being suggested in research. In general, evidence suggests that the cause of patellofemoral pain can be linked to the inability for the knee joint to tolerate an increase in stress, which may be due to various factors.
Previously, it was thought that patellofemoral pain was caused by poor bone alignment, but recent research suggests this contributes less than originally thought. Patellofemoral pain is multifactorial, meaning there can be many factors that may contribute to the development of this condition. Some of these factors can be intrinsic, those that are related to your body; while others can be linked to extrinsic factors, those that are due to things outside of your body.
Intrinsic factors for Patellofemoral Pain
Some of these intrinsic factors include those around your knee:
- Weakness of your quadricep muscle
- Weakness of various muscles around your hip, such as your hamstring or glutes
- Delayed muscle activation in your quadricep muscle
- Decreased flexibility in various muscles of your leg, including your quadricep, hamstrings (back of your upper leg), and gastrocnemius (calf)
- History of patellofemoral pain
Extrinsic factors for Patellofemoral Pain
Mostly involve things around your recent activities that can increase the stress through your knee joint beyond its capacity:
- Starting a new activity very suddenly, such as running or cycling
- Either of these situations can be explained by the notion of an activity being done “too much, too soon, too often, and/or too fast”
- For those that run, examples of this can be an increase in distance, a faster pace, more frequent sessions each week and/or decreased rest time between sessions
- Making changes to an activity you are already familiar with
- Changing where you run: uphill or around a track can also be a factor, as well as changing the type of shoe you wear
- In general, shoes with a higher amount of cushion tend to increase shock absorption to the knees and the hips and may have an impact in the development of patellofemoral pain
- Changing where you run: uphill or around a track can also be a factor, as well as changing the type of shoe you wear
- Lifestyle factors have a big influence on the body’s ability to rest and recover after activity, which is an important part of any injury prevention, as well as rehabilitation
- Poor sleep quality and/or quantity as well as psychological stressors can restrict your body’s ability to rest and recover. For more information on this topic, please see Why Sleep is Important for Recovery & Health
Photo by Pavel Danilyuk from Pexels
Do you think you have Patellofemoral Pain?
Book an assessment with one of our physiotherapists. Book hereHome exercises for Patellofemoral Pain
Now that you are aware of the various things that could lead to the development of PFP, you may be able to think back on your recent activity and note any of these factors that might apply to you. No matter what the cause may have been, evidence suggests that active based exercise therapy should always be first-line treatment for patellofemoral pain to reduce pain and improve function.
First, it is important to understand that you can still continue with your usual activities with some modifications on how much, how often and/or how fast you are doing these exercises. This will be specific to your unique condition, with gradual progressive re-exposure to your level of activity.
Your rehab should focus on strengthening exercises for various muscles of your leg. A combined strengthening program, as opposed to simply focusing on the knee, has been shown to have the best results to decrease pain and increase function. Here are examples of both weight bearing and non-weight bearing exercises you can try:
Leg Raises
Squats
Glute Bridges
Calf Raises (Knees Straight)
Four Point Abduction / Extension
Calf Raises (Knees Bent)
Pain relief techniques for Patellofemoral Pain
Commonly used pain relief techniques can have benefits when used in combination with exercise.
Taping has been found to be beneficial for immediate symptom reduction. Taping can also enhance the outcomes of exercise therapy but only temporarily (~4 weeks). Beyond this time frame, taping may not be beneficial.
The use of supportive shoe inserts is controversial. Evidence suggests that the use of shoe insoles may be beneficial for short-term pain relief, but it does not recommend their use beyond 6 weeks. This evidence also suggests that off-the-shelf shoe insoles may be more effective than the more expensive custom-made orthotics. So no need to break the bank!
Recent evidence suggests that a knee brace is not recommended for recovery.
Other techniques that may be used are: heat, ice, massage, needling and electromodalities (TENS, IFC, US). However, there is currently very little research that supports these techniques for their use with patellofemoral pain.
Gait retraining can be a beneficial treatment option, but it is recommended to seek professional guidance.
Factors that can influence recovery
Various factors can influence your recovery, including the lifestyle factors that were previously mentioned as risk factors. Evidence suggests that psychological factors can play a role in the road to recovery. For example, when compared to the general population, those with patellofemoral pain are found to have higher instances of anxiety, depression, catastrophization and fear of movement. These factors can lead to higher levels of pain and reduced physical function in individuals with PFP; therefore, it is especially important to think about these psychological factors as part of your recovery process.
How long does it take to recover from Patellofemoral Pain?
Patellofemoral pain does not have a predetermined timeline for recovery due to its complexity and how it presents for each person. In some people, the pain can persist if treatment recommendations are not adhered to long-term. For others, it can persist if the treatment is focused on short-term pain relief.
As a result, patellofemoral pain can have a high recurrence rate of up to 70% due to the difficulties in addressing the possible contributing factors. Additionally, because of these various possible causes, there can be a variety of different types of treatment combinations that are catered towards each individual. Therefore, your rehabilitation may require some trial and error with the treatment options to help you achieve your recovery goals.
Should I still exercise when I have Patellofemoral Pain?
Even though the research is unclear on your exact recovery process, the good news is that you can still be active (and it’s actually encouraged) as long as it’s done with some modifications and monitoring of your symptoms.
Movement is key to recovery and should not be feared or avoided. As mentioned, strengthening, especially of the hips and lower body, is one of the only effective treatments for PFP so focus should be on movement and getting stronger. Knowing where to start can be tricky. A simple place to begin would be with whatever exercise you are comfortable with, whether that be walking or bodyweight squats.
If you are looking for more guidance on where to start or how to progress, seek the advice of a physiotherapist.
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