Physio Penrith Patellofemoral Knee Pain Treatment

Treatment of Patellofemoral Knee Pain at Sydney Muscle & Joint Physio Penrith

What is patellofemoral knee pain?

Patellofemoral pain is a common musculoskeletal-related condition that is characterised by insidious onset of poorly defined pain quality localised to the anterior retropatellar and/or peripatellar region of the knee. Prevalence ranges from 3% to 85% for idiopathic anterior knee pain or patellofemoral pain and its associated diagnoses, with a prevalence of 25% being the most frequently cited.

What are the symptoms of patellofemoral knee pain?

The onset of symptoms can be slow or acutely develop, with a worsening of pain about the front of the knee with lower-limb loading, including squatting, prolonged sitting, ascending/descending stairs, jumping, or running, especially with hills. While many pathoanatomic correlates, such as internal derangement or cartilage softening, have been offered all are poorly associated with symptoms. A number of studies reported that a large majority of these individuals reported at least some difficulty with squatting (93.7%), stair negotiation (91.2%), and running (90.8%). People with patellofemoral pain syndrome tend to ascend and descend stairs with reduced knee flexion. More than half (54.4%) of people with patellofemoral pain syndrome reported pain with prolonged sitting; another 26.4% reported pain with sitting after exercise. Only 19.2% of people could sit without pain. 

How do you diagnose patellofemoral knee pain?

Compared with healthy, matched controls, people who develop patellofemoral pain syndrome have weaker quadriceps, quadriceps atrophy (or reduced size of quadriceps) is also a common finding in individuals with patellofemoral pain syndrome. People with patellofemoral pain syndrome also have weakness of the hip abductors, extensors, and external rotators (glut muscles). Rate of force development of the hip abductors and extensors is also reduced in people with patellofemoral pain syndrome. Systematic reviews of diagnostic tests for patellofemoral pain syndrome demonstrate that the majority of clinical tests have poor diagnostic accuracy and therefore physiotherapists should use reproduction of retropatellar or peripatellar pain during squatting as a diagnostic test for patellofemoral pain syndrome. Physiotherapists should also use performance of other functional activities that load the patellofemoral joint in a flexed position, such as stair climbing or descent, as diagnostic tests for patellofemoral pain syndrome. Physiotherapists may use the patellar tilt test with the presence of hypomobility to support the diagnosis of patellofemoral pain syndrome.

Read more here about "how to confirm if your knee pain is patellofemoral pain syndrome".

Treatment of patellofemoral knee pain

Patellofemoral pain has an annual prevalence of approximately 23% of adults and 29% of adolescents in the general population and affects almost 36% of professional cyclists. Patellofemoral pain tends to persist in about 50% of people and  in some cases for up to 20 years, with the associated pain and symptoms often limiting participation in daily and occupational tasks and reducing levels of physical activity. Most importantly, patellofemoral pain may precede the onset of patellofemoral osteoarthritis which has no cure.

At Sydney Muscle & Joint Physio Penrith our philosophy is to provide research supported interventions for patellofemoral knee pain. The International Patellofemoral Research Retreat takes place every two years and aims to share the latest patellofemoral pain research developments and discuss the literature to formulate consensus statements to disseminate knowledge. Below are the very latest research supported treatments for patellofemoral knee pain and one that our physiotherapists in Penrith support and utilise:

  • Exercise therapy - is the intervention of choice for patellofemoral pain, with the largest body of evidence supporting its use to improve pain and function in the short, medium and long terms. Our physiotherapists in Penrith acknowledge that exercise targeting the hip and knee is a key component of management for all patients with patellofemoral pain, particularly when used in combination.

  • Combined hip and knee exercises - rather than knee exercises alone. This most recent patellofemoral consensus statement recommends combined hip and knee exercises to reduce knee pain and improve function in the short, medium and long terms, and this combination should be used in preference to knee exercises alone.

  • Multiple modalities - another recommendation to reduce pain in adults with patellofemoral pain in the short and medium terms was combined interventions and this is the one of the key approaches by our physiotherapists at Sydney Muscle & Joint Physio Penrith; that being multimodal techniques. Combined interventions as a management programme incorporates exercise therapy as well as one of the following: foot orthoses, patellar taping or manual therapy.

  • Foot orthoses - recommended to reduce pain in the short term. Prefabricated foot orthoses remain a recommendation for short-term relief of patellofemoral pain. There is no evidence supporting the use of custom-fabricated foot orthoses for patellofemoral pain, which are made from a three-dimensional representation of the patient’s foot. At Sydney Muscle & Joint Physio Penrith we recommend an over the counter prefabricated orthotic to help mange your knee pain in the short term and as a way to improve adherence to an exercise program.

  • Patellofemoral, knee and lumbar joint mobilisations - not recommended as primary interventions or in isolation when managing patients with patellofemoral pain. It should be noted that patellofemoral mobilisation can be used as a component of a combined intervention approach where appropriate, with evidence and expert opinion in support. Our physiotherapists in Penrith acknowledge the shift towards active, movement-based physical interventions for patellofemoral pain and musculoskeletal pain more broadly, and whilst these joint mobilisations are not the focus, they may help to improve the adherence to an exercise program.

  • Electrophysical agents - such as ultrasound, phonophoresis and laser therapy does not improve pain or functional outcomes in oatients with patellofemoral knee pain in the short term are therefore not recommended.