Overview of Patellofemoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome (PFPS) is a common orthopedic term used to describe pain around or behind the patella (kneecap). It often is referred to as “Runner’s Knee” or “Jumper’s Knee” due to its frequency with those activities. It typically occurs due to increased stress on the patellofemoral joint, often linked to overuse, poor biomechanics, or muscular imbalances.

Causes

1. Overuse: Repetitive knee motion from activities like running, cycling, or jumping can overload the patellofemoral joint.

2. Biomechanical Issues:

   • Misalignment of the patella within the femoral groove.

   • Weakness or imbalances in the quadriceps, hamstrings, or gluteal muscles.

   • Flat feet (overpronation) or high arches affecting lower limb alignment.

3. Trauma: Direct injury to the kneecap can contribute to the development of PFPS.

4. Training Errors:

   • Sudden increases in activity intensity or duration.

   • Inadequate recovery time.

5. Improper Equipment: Worn-out footwear or improper orthotics.

Symptoms

• Pain Location: Around or behind the kneecap, especially during activities like climbing stairs, squatting, or sitting for prolonged periods (theater sign).

• Crepitus: A grinding or cracking sensation in the knee.

• Swelling: Mild, localized swelling in some cases.

• Pain Aggravation: Activities like running downhill or kneeling may worsen symptoms.

Diagnosis

1. Medical History: Understanding activity levels, onset, and aggravating factors.

2. Physical Examination:

   • Palpation of the knee for tenderness.

   • Assessing range of motion and strength.

   • Evaluating gait and alignment.

3. Imaging (if necessary):

   • X-rays or MRI may be used to rule out structural issues but are not routinely required.

Treatment

Conservative Management:

1. Rest and Activity Modification: Reducing activities that exacerbate symptoms while maintaining low-impact exercises like swimming or cycling.

2. Physical Therapy:

   • Strengthening exercises for the quadriceps, gluteals, and core.

   • Stretching of tight muscles (e.g., hamstrings, calves, iliotibial band).

   • Patellar taping or bracing to improve tracking.

3. Footwear and Orthotics:

   • Using supportive shoes or custom orthotics to correct alignment issues.

4. Pain Management:

   • NSAIDs (non-steroidal anti-inflammatory drugs) for short-term relief.

   • Ice packs applied after activity.

Advanced Treatment (if conservative measures fail):

• Injections: Rarely used but may include corticosteroids or viscosupplementation.

• Surgery: Reserved for cases with structural abnormalities, such as lateral release or realignment procedures.

Prevention

• Gradual increases in training intensity.

• Regular strengthening and flexibility exercises.

• Wearing proper footwear.

• Avoiding prolonged periods in a single position (e.g., sitting or squatting).

Prognosis

Most individuals with PFPS respond well to conservative treatment. Early diagnosis and adherence to rehabilitation programs are key to a full recovery. However, recurrence is possible if underlying causes (e.g., weak muscles or poor biomechanics) are not addressed.