What are the most common symptoms of PFP?
general ache/pain in the front of the knee
pain aggravated activity involving a bent knee and body weight on the leg (e.g. walking up and down stairs, squatting, kneeling, jumping or hopping)
pain aggravated by sitting for prolonged periods e.g. driving or sitting in a movie theatre.
some people also hear and feel a grinding / clicking around the knee with mild swelling
An x-ray or MRI is not usually necessary to diagnose PFP.
Patello-femoral pain is often mis-diagnosed as knee osteo-arthritis in young people, due to the deep ache that is often felt.
An assessment by a Physiotherapist will help to clarify your diagnosis.
Who is most likely to be affected by PFP?
The main risk factor for developing PFP is recent spike in training load.
PFP is common in:
runners
cyclists
triathletes
cross fitters
football, basketball, jumping sports
hikers (especially going downhill)
Biomechanical issues that can predispose to PFP include:
weakness in glutes, quads (VMO), core, calves
tight ITB, TFL, quads (outer), hamstrings, calves
stiffness in ankles (e.g. post ankle sprain)
stiffness in the hip joints / hip flexors
runners with who predominantly heel strike
White et al (2009) showed that patients with patellofemoral pain had shorter hamstring muscles than asymptomatic controls.
What is the most effective treatment?
There is strong evidence to support a tailored physiotherapy (including exercise, education, taping), compared to placebo in the short (six weeks) and long-term (one year).
Evidence shows a personalised exercise program (combination of stretching and strengthening) gives the best long term outcomes.
Ideally this exercise program is set up by a Physiotherapist after a comprehensive assessment.
How long until I feel better?
As our understanding has grown, it has become clear that PFP is not necessarily something that will disappear on its own, and some people can have episodes on and off for many years.
As such, in order to have the best chance of recovering from your PFP and reducing the likelihood of it recurring, it is important to understand your condition, your individual contributing factors and what you can do.
For many people, a program of ongoing and progressive exercise (as prescribed by your physiotherapist) is necessary to build and maintain muscle strength, and good movement coordination.
Additionally, there is evidence suggesting that people with PFP may have an increased risk of going on to develop patellofemoral osteoarthritis (OA). Therefore, seeing an experienced physiotherapist for a management program will help you keep your patellofemoral joints functioning as well as possible, and keep you as active as you’d like to be now and into the future.
What can I do?
avoid aggravating activities
ice your knee to eliminate the inflammation (15 mins x 2 day for 2 weeks)
home exercises - foam rolling (see below) and strengthening
For Runners:
avoid hills
cut back on your running mileage
increase your cadence by 5-10%
check your shoes - time for a new pair?
focus on cross training - swimming, pilates, yoga e.t.c.
Some of the common foam roller exercises we prescribe: