Patellofemoral Pain

 

Knee pain is a common problem, both in the general population and sports people. It accounts for a large portion of 20-40% of all GP practice visits related to the musculoskeletal system, and is a common problem we see in Physiocare. There can be several causes and types of knee pain, and today we’re going to be specifically talking about patellofemoral pain. Patellofemoral pain (PFP) is defined as pain around or behind the knee cap (patella), that is aggravated by weight bearing on a bent knee.

 

PFP has been shown to affect up to 22.7% pf the general population, and up to 29% of adolescents. It is unclear what exactly causes PFP or puts people at risk of developing it. However, several factors have been identified, such as: reduced strength of the knee and hip muscles, increasing training load too quickly or by too much, increased BMI, and potentially biomechanical issues. 

So, how can you tell if you suffer from patellofemoral pain? While a full clinical assessment by a Chartered Physiotherapist should be the first port of call in order to rule out other problems of the knee, there are some symptoms characteristic of patellofemoral pain. Pain that comes on when putting weight through the knee when it is bent is a core criterion for diagnosing PFP. An example of this would be going up or down stairs, or when squatting or lunging. Again, there can be several causes of knee pain which can cause the above symptoms, and if you wish to accurately diagnose and treat the cause of your knee pain, consult your chartered physiotherapist.

Now that’s all well and good, but how do we improve your knee pain? Or, even better, how do we reduce the chance of you getting it in the first place? The overwhelming weight of the evidence tells us that strengthening of the knee and hip muscles is the most effective way to treat PFP. Other treatment techniques such as taping, massage/manual therapy, orthotics etc can be considered depending on the patient, but pain-free strengthening work should be the first port of call. 

The good news is that this doesn’t have to be complicated or fancy. I’m sure most of you know what a squat or a lunge is, and these are very effective and simple exercises to strengthen the knee and hip muscles (quads and glutes). The latest research also tells us that some dedicated hip strengthening is also likely a good idea for PFP, so some glute bridges, clams and side lying hip abductions are great (and simple!) ideas too. If you are unsure of how to do these exercises, consult our exercise database here: https://physio.ie/patient-exercies/hip-exercises/ and https://physio.ie/patient-exercies/knee-exercises/

Furthermore, a surefire way to reduce your risk of injury and pain (especially for runners and athletes) is to manage your training load. Simply, what this means is: don’t do too much too soon! For more information on this very important topic, see here: https://physio.ie/little-by-little-an-introduction-to-load-management/ 

Of course, this is not intended to diagnose or treat any pathology of the knee or otherwise. If you are unsure of the cause of your knee pain, or are unclear about any topic raised here, feel free to book an appointment with one of our Chartered Physiotherapists at PhysioCare.

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Further Reading

  1. Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries
  2. Smith, B.E., Selfe, J., Thacker, D., Hendrick, P., Bateman, M., Moffatt, F., Rathleff, M.S., Smith, T.O. and Logan, P., 2018. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PloS one, 13(1), p.e0190892.
  3. Neal, B.S., Lack, S.D., Lankhorst, N.E., Raye, A., Morrissey, D. and van Middelkoop, M., 2019. Risk factors for patellofemoral pain: a systematic review and meta-analysis. Br J Sports Med, 53(5), pp.270-281.

Nascimento, L.R., Teixeira-Salmela, L.F., Souza, R.B. and Resende, R.A., 2018. Hip and knee strengthening is more effective than knee strengthening alone for reducing pain and improving activity in individuals with patellofemoral pain: a systematic review with meta-analysis. journal of orthopaedic & sports physical therapy, 48(1), pp.19-31.