Patellofemoral Pain Syndrome (PFPS)

Patellofemoral joint pain syndrome is the most commonly diagnosed cause of knee pain at the front of the knee. It is so common its often known as runners knee or jumper’s knee. But really, it’s a broad umbrella term for the sort of vague pain that seems to originate from the front of the knee or just behind the patella or knee cap.

Exactly why your knee pain occurs is sometimes tricky to determine but physiotherapists will look at the anatomical, biomechanical, behavioural, and psychological factors that relate to your knee and how it’s being used.

One factor that is very common in people with patellofemoral pain syndrome (PFPS) is quadriceps weakness or relative quadriceps weakness. There is some debate in the literature whether it is the teardrop shaped vastus medialis (on the inside of your thigh towards your knee) that is the weaker than the vastus lateralis (on the outside) but the research does agree that generalised quad weakness is a worthy target for physiotherapists to work on when rehabilitating PFPS.

Like in the quads weakness in the hips is commonly found in people with PFPS. However, it is not generally found to cause someone’s knee pain rather it is the result of having knee pain for a prolonged period of time. Research suggests that training your hip strength in various ranges of motion can be beneficial to improving your knee pain. It’s a good idea to speak to your physio to have some guidance on what exercises are right for you to train the hip but not flare up the knee at the same time. Everyone is a little different so a personalised approach will give you the best results.

Another factor commonly seen in people with PFPS is quad tightness particularly in the vastus lateralis or outer quad. There is evidence to suggest that when this muscle is particularly tight it can pull the patella (or Kneecap) outwards causing uneven pressure and tension that can cause pain. This is also known as patella mal-tracking. Studies have shown that stretching alone is not often enough to loosen the vastus lateralis and deep tissue work such as that done by a physio or foam rolling as well as stretching in combination is what is required to make meaningful changes in the tissue.

Often what physios see as one of the biggest issues in PFPS and lots of other conditions is loading issues or changes in load that occur too rapidly for the body to keep up. The human body is an amazing adaptation machine, but it doesn’t happen all at once. It takes time and sensible load increases to ensure it stays running well. Cold starting your car and then redlining the engine doesn’t do your car much good and it’s the same for your body. Skipping a preseason and getting straight into a normal training volume is often a cause of pain in athletes and care should be taken to avoid large increases in volume without the proper preparation. Literature shows that for PFPS a 30% increase in mileage over 2 weeks made runners far more vulnerable to injury. Physiotherapists can assess your training volume and give you strategies to modify your training load to allow you to keep doing the sports or activities you love while successfully rehabilitating your knee pain at the same time.

Struggling with knee pain that just won’t go away?

At Nelson Bay Physiotherapy & Sports Injury Centre, we specialise in diagnosing and treating conditions like Patellofemoral Pain Syndrome with personalised, evidence-based care. Whether you’re an athlete, weekend warrior, or just want to move pain-free again, our experienced physios are here to help.

📞 Call us today on (02) 4981 3461

💻 Or book online anytime via our online booking platform: www.nelsonbayphysio.com.au

Don’t let knee pain slow you down — take the first step towards recovery today!

Written by Rhys Bubb

References:

Duong, V., Oo, W. M., Ding, C., Culvenor, A. G., & Hunter, D. J. (2023). Evaluation and treatment of knee pain: a review. Jama, 330(16), 1568-1580.

Hudson, Z., & Darthuy, E. (2009). Iliotibial band tightness and patellofemoral pain syndrome: a case-control study. Manual therapy, 14(2), 147-151.

Nielsen, R. Ø., Parner, E. T., Nohr, E. A., Sørensen, H., Lind, M., & Rasmussen, S. (2014). Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury. journal of orthopaedic & sports physical therapy, 44(10), 739-747.

Pappas, E., & Wong-Tom, W. M. (2012). Prospective predictors of patellofemoral pain syndrome: a systematic review with meta-analysis. Sports health, 4(2), 115-120.

Rathleff, M. S., Rathleff, C. R., Crossley, K. M., & Barton, C. J. (2014). Is hip strength a risk factor for patellofemoral pain? A systematic review and meta-analysis. British journal of sports medicine, 48(14), 1088-1088.

Sisk, D., & Fredericson, M. (2019). Update of risk factors, diagnosis, and management of patellofemoral pain. Current reviews in musculoskeletal medicine, 12, 534-541.

van der Heijden, R. A., Lankhorst, N. E., van Linschoten, R., Bierma‐Zeinstra, S. M., & van Middelkoop, M. (2015). Exercise for treating patellofemoral pain syndrome. Cochrane Database of Systematic Reviews, (1).