Patellofemoral Pain (PFP)

Patellofemoral pain (PFP)

PFP is pain from the tissues within or surrounding the joint between the knee cap (patella) and the thigh bone (femur). The patella rests in a groove on the femur where it acts like a pulley to transmit the force of the quadriceps muscle (thigh muscle) onto the tibia via the patella tendon.

The cause of pain in PFP is not completely understood, but most research seems to point to involvement of the joint synovium which is a membrane that surrounds the actual joint. However, there are several structures including the lateral retinaculum, plica, bursa and infra- patella fat pad that may be a source of pain and it may differ from person to person.

Like so many conditions in modern medicine, as the knowledge expands we begin to appreciate that pain is incredibly complex, and we are often unable to identify a specific structure as the culprit. The good news is this doesn’t affect management, and in fact allows a simple but holistic approach to rehabilitation.

Do you have PFP?

If you suffer from pain at the front of your knee that is generally non-specific or vague in nature; stiff when you’ve been sitting for a prolonged time; aggravated with repetitive squatting, running, stairs or kneeling; and sometimes you feel or hear it grinding; you may be suffering from PFP.

What causes PFP?

From the literature we can divide the causes into broad categories – muscle weakness (especially glutes and quads), decreased control of movement such as your leg and trunk, altered biomechanics, tissue tightness (ITB, quads and hips flexors, hamstrings and calf muscles) and even psychosocial factors (sport, work, stress, mental health). Often people have combinations of these causes which need to be addressed.

How do we manage PFP?

In general, the approach involves:

• Settle symptoms and inflammation by reducing load on the patella and surrounding tissues . This may involve techniques such as taping , technique / activity modification , hands-on physiotherapy techniques and if needed taking non-steroidal anti-inflammatories (NSAIDS). Rest by itself is often not the answer.
• Identify the cause(s) of problem.
• Rehab by targeting the cause(s) that have been identified.
• Follow a graduated loading program to return to normal activities and strengthen to reduce the chances of recurrence.