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Treatment for Patellofemoral (Knee/Kneecap) Pain

What is Patellofemoral Pain?

Patellofemoral pain is also known as runner’s knee. However, this condition is not limited to runners. It is broadly used to describe several knee problems ranging from mild to severe discomfort. Patellofemoral pain originates from the contact of the back of the kneecap with the thigh bone (femur).

Patellofemoral pain is a common knee complaint of both young, active people and the elderly. It mostly occurs from excessive patellofemoral joint pressure and poor kneecap alignment. In some cases, chondromalacia patella is present. This is the breakdown or softening of the articular cartilage on the underside of the kneecap, which can lead to inflammation and pain in the underlying bone.

What Are the Symptoms of Patellofemoral Pain?

Knee Pain is the most common symptom – either general pain around the kneecap, or localised pain behind the kneecap. You might have difficulty isolating the exact location of the pain because the point of initiation is different from where you feel the pain.

Pain initiates when you put pressure on the knee through an activity such as squatting, running, sitting for extended periods or walking up and down stairs.

Other symptoms include:

  • The knee gives way
  • You hear noises when moving your knee
  • You might experience a reduced knee flexion during activities

What Are the Causes of Patellofemoral Pain?

There are a number of factors that can cause patellofemoral pain. These include:

  • Trauma: A direct hit to the knee from a blow or fall.
  • Injury: Trauma to the kneecap such as a fracture or dislocation.
  • Overuse: High-stress exercises such as lunges, plyometrics, squats or bending your knees continuously can irritate the tissues around your kneecap.
  • Muscle weakness: This occurs when the muscle around the knee or hip does not align your kneecap properly. It is usually associated with inward movement of the knee when in a squat position.
  • Feet problems: These include hypermobile feet, flat feet or overpronation. They alter the way you walk and result in knee pain.
  • Chondromalacia patella: A condition where the cartilage under your kneecap breaks down.
  • Maligned bones: A condition where the bones from your hips to your ankles are out of position. This puts pressure on your kneecap and causes pain.

How is Patellofemoral Pain Diagnosed?

Your doctor will discuss your general health during a physical examination, as well as the symptoms you are experiencing. They will ask where the pain started, and the nature and severity of the pain. Your doctor might gently pull and press the front of your kneecaps and knees. They might ask you to lunge, squat or jump during the exam to test your core knee strength.

To rule out other physical problems and diagnose the exact cause of your pain, your GP might also check:

  • Kneecaps for signs of tenderness
  • The position of the kneecap and alignment of the lower leg
  • Flexibility, strength and firmness of the hamstrings, quadriceps and hips
  • Order an X-ray to rule out damage to the knee structure and connecting tissues

Treatment of Patellofemoral Pain

  • Exercises: Exercise therapy is the first line of treatment for patellofemoral pain syndrome. Exercises are recommended based on the type of joint movement, muscle activity and reaction forces. Exercises are designed to strengthen the quadriceps and stabilise the patella. The quadriceps are the main stabilisers of the kneecap so most of the therapy focuses on this area.
  • Orthotics: Your GP might recommend shoe inserts to align and stabilise your ankle and foot. It also relieves stress from your lower leg.
  • Medication: Over the counter medication includes pain relievers such as acetaminophen, naproxen sodium and ibuprofen.

Will Patellofemoral Pain Require Surgery?

In the event that nonsurgical treatment doesn’t work, your GP may suggest one of the following procedures:

  • Realignment: A knee operation that relieves pressure on the cartilage and realigns the angle and the kneecap.
  • Lateral release: This procedure involves cutting through the lateral retinaculum tendon in the cases that it is too tight, so that the patella can slot back into the trochlear groove and restore correct alignment.
  • Arthroscopy: A procedure in which a doctor makes a tiny incision and inserts a thin device into your knee to remove damaged cartilage.

Patellofemoral Pain FAQ’s

Who is at risk of getting patellofemoral pain?
Individuals who play high impact sports such as tennis, soccer, football, basketball or running. Other activities include playing on multiple surfaces and running on trails or hills.
What are the initial signs of patellofemoral pain?
A dull ache under your kneecap while squatting, walking up or down the stairs or sitting for long periods of time.
Does patellofemoral pain go away on its own without treatment?
Patellofemoral pain sometimes goes away on its own, but usually basic physical therapy exercises are needed. 90% of individuals suffering from patellofemoral syndrome are pain-free within six weeks.
How long does patellofemoral pain take to heal?
People heal at different rates. If surgery is necessary, it is usually 6-12 weeks before a patient has full knee extension and complete knee mobilisation.

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