Do you have knee pain? It could be PatelloFemoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome or PFPS is a term used to describe pain at the front of the knee or around the knee cap. There’s usually increased pain with descending stairs, walking downhill or sitting for long periods of time and rest or straightening the knee will usually feel relieving. Whether you have been diagnosed with PFPS or simply feel like your symptoms fit, you may benefit from having a read of some of the latest research on the topic.

What’s causing the pain?

The most widely accepted theory in regards to the cause of the pain in PFPS is an increased pressure of the kneecap on the underlying bones. This could be either at rest or when doing activity and is referred to as patellofemoral malalignment or maltracking. (4)

What exercises are effective according to the research?

  • Getting the bones around the knee and knee cap aligned while performing functional exercises can be helpful however you will need to enlist the help of a trained professional such as a Clinical Myotherapist or Clinical Pilates Trainer to learn how to do this either with your hands or with tape. (2)
  • Strengthen your quad muscles. Depending on your fitness and current strength this could be a straight leg raise or squats just to name a few. (2)
  • Stretch the hamstrings, quads, calf and front of the hip including the ITB (Iliotibial band). If this is all gobbledygook to you, there are hundreds of YouTube clips to help just type in the muscle you want to stretch and the word stretch. (2)
  • Squats with a wide stance (slightly wider than hip width apart or more; or to be exact between 40 and 80 degrees of hip abduction) have been shown to activate the vastus medialis obliquus or VMO muscle. This muscle has been shown to be weak in people with PFPS but they are not sure if it is a cause or effect. Either way it is worth strengthening it according to the research. (1)

What exercises are not effective, according to the research?

  • There is some evidence that strengthening the hip muscles will assist with PFPS but other studies showed no improvement over the quadriceps strengthening exercises alone. Therefore hip strengthening should not be your primary exercise focus.(2) Some examples of hip strengthening exercises are clams, single leg squats and lunges to name a few.
  • Supervised exercise was found to be no more beneficial than unsupervised exercises.(2) However I strongly suggest you enlist the help of a trained professional to get you started such as a Clinical Pilates Instructor, Clinical Myotherapist or Physiotherapist.
  • Only focusing on the VMO strengthening was shown to be less effective as the evidence is pointing towards multiple factors being involved in PFPS. (3)(4)

What do I need to be careful with?

  • Doing too many knee flexion and extension exercises as this may aggravate your pain. Keep the reps and weight low when doing things like a squat or lunge and slowly build up to higher amounts and more weight. All exercises should be pain free and other than muscle soreness you should not feel increased pain the following day.
  • Going too deep in knee flexion as this may aggravate your symptoms. Start with shallow squats and lunges and as your strength builds and pain is reducing you can slowly bring yourself into a deeper posture.
  • Sitting for too long as this may aggravate your PFPS. The amount of time tolerable can be different for everyone and you probably already know how long you can tolerate. If you happen to sit for too long, come up slowly and carefully.
  • Put yourself in an unstable position or on a unstable surface until you are well on your way to recovery. There is an increased chance that you may fall with PFPS because the muscles around the knee aren’t getting proper nerve signals. This will improve with the exercises but you need to be careful in the initial rehabilitation phase. (2)
  • Kneeling as this may aggravate your symptoms. Putting something soft down can help relieve this problem such as a Pilates mat or some foam.

What non-exercise treatments have been shown to be effective?

Unfortunately good quality PFPS research is lacking when it comes to non-exercise treatments. The below treatments may be advantageous for some people with PFPS.

  • Kinesio Tape can be beneficial in the initial stages to help with knee proprioception (the connection between the brain and the knee) when combined with low impact rehabilitation exercises. It is not appropriate to use with high impact exercises such as running. (5)
  • Myofascial release and self myofascial release to reduce general musculoskeletal pain.(6) This may involve trigger point therapy, dry needling or massage if you get treatment with a Clinical Myotherapist or Physiotherapist. If you want to do it at home you can use a foam roller or spikey ball for example and massage the legs and glutes yourself. Again YouTube clips are helpful to get the right technique or ask your therapist to show you.
  • Ice, ultrasound, biofeedback, neuromuscular electrical stimulation and laser may be beneficial in combination with exercises however alone they showed no improvement.(7) All these therapies excluding the ice would be administered by a trained professional such as a Clinical Myotherapist or Physiotherapist.
  • Taping specific to your needs (i.e for lateral glide, rotation etc…) can be beneficial in early stages but loses effectiveness at 4 weeks and research showed no changes at 3-12 months.(8) Again Clinical Myotherapists and Physiotherapists should be trained is administering this technique.
  • Orthotics showed benefit over no treatment.(9) However this could be a simple arch support from the chemist, you don’t necessarily need a expensive molded orthotic in this case.
  • Surgery should be considered only after failure of a comprehensive rehabilitation program.(10)

I hope you enjoyed the read and that you got some new ideas on what to do next in the recovery of your knee pain. If you have further questions or would like some specific advice you can contact us at info@waverleymyotherapyclinic.com.au

Resources

  1. Eun-Mi Jang et al. Journal of Physical Therapy Science 2013. Activation of VMO and VL in squat exercises for women with different hip adduction loads.
  2. Demetris Stasinopoulos et al. The Open Sports Medicine Journal 2015. A systematic Review of Reviews in Patellofemoral Pain Syndrome. Exploring the Risk Factors, Diagnostic Tests, Outcome Measurements and Exercise Treatment.
  3. Els pattyn, PT et al. American Journal of Sports Medicine 2011. Vastus Medialis Obliquus Atrophy Does it Exist in Patellofemoral Pain Syndrome?
  4. Frances T. Sheehan (PhD) et al. Clinical Biomechanics (Online) 2012. Alterations in in vivo Knee Joint Kinematics Following a Femoral Nerve Branch Block of the Vastus Medialis: Implications for Patellofemoral Pain Syndrome.
  5. Freedman (PT) et al. Sports Health 2014. Short-Term Effects of Patella Kinesio Taping on Pain and Hop Function in Patients With Patellofemoral Pain Syndrome.
  6. Adelaida Maria Castro-Sanchez et al. Clinical Rehabilitation 2011. Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial.
  7. David A. Lake et al. Sports Health 2011. Effect of Therapeutic Modalities on Patients with Patellofemoral Pain Syndrome: A systematic Review.
  8. Christian Barton et al. British Journal of Sports Medicine 2013. Patellar taping for patellofemoral pain: a systematic review and meta-analysis to evaluate clinical outcomes and biomechanical mechanisms.
  9. April D. Jessee (MS) et al. Journal of Athletic Training 2012. Bracing and Taping Technques and Patellofemoral Pain Syndrome.
  10. Sameer Dixit et al. American Family Physician 2007. Management of patellofemoral pain syndrome.

 

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