Patellofemoral Pain
The Highlights
Patellofemoral Pain (PFP) is pain at, around and behind the knee cap, usually brought on during activity, using stairs or long periods of sitting. It is sometimes called patellofemoral pain syndrome or anterior knee pain.
Our team can provide expert assistance in diagnosing this condition and ruling out other problems (such as patella tendinopathy) as well as analyse your biomechanics to look for potential areas to be addressed.
Treatment at different stages may include taping, foot orthoses (specialist insoles), gait retraining and progressive loading exercises.
What is it and what are the symptoms?
PFP describes pain at, around and behind the patella (knee cap). Exactly "what" it is remains up for debate in the research - the exact tissues responsible for pain are not clear but what we do have is sound evidence of what seems to help people reliably get better.
Alongside the location of pain around the patella, the progression of pain (it usually starts subtly and builds over time) and the things that bring on the pain can be a useful clue you have PFP - squats, lunges, jumping, running, climbing stairs and prolonged periods of sitting can all be provocative. There may also be associate swelling (usually mild) and crepitus (a creaking sensation around the patella).
Why does it happen?
PFP, as we've already mentioned, is not fully understood but is at least understood to have an overloading component - in essence, the amount of mechanical load or stress the structures around the anterior knee can take on a daily basis has been exceeded too many times for it to keep up with healing and adapting. This often follows a clear "spike" in load - a sudden increase in walking or running mileage, a change in profession (those on their feet a lot for work are particularly prone to this condition), a change in shoes, weight-gain as well as emotional and psychological stresses can all play an important role.
What are the treatment options?
Prior to carrying out any treatment plan, our Podiatrists carry out a medical history taking and physical examination of your feet, ankles and lower limbs as necessary. We may also recommend further examination such as gait analysis which is available in-house. Diagnostic imaging is rarely required unless symptoms are not improving. PFP is considered a diagnosis of exclusion meaning our Podiatrists will diagnose it by first ruling out other knee pain conditions like actual knee joint pain, patella tendinopathy and iliotibial band syndrome.
Once diagnosis is confirmed, we can look at different ways to offload the injured tissues and tailor a progressive exercise programme to your requirements. Strengthening of both knee, and hip related muscles is a very well established part of treatment and, if done correctly, gives the injured tissues the right amount of exposure to stress in order to adapt and heal. We may also look at gait retraining to change your movement patterns for a period of time so you can work around the problem which gradually being exposed to increased load.
To aid in your rehab programme, we may also look to employ other techniques: both taping and foot orthoses (specialised insoles) have been demonstrated to relieve symptoms very well in the short term for most patients and foot orthoses may continue to be useful in a subset of patients over a longer period.
