Patellofemoral pain syndrome (PFPS) is characterized as knee pain that is generated by the kneecap joint and associated soft-tissue structures surrounding the patellae (kneecap). It is considered the “black hole of orthopedics”, as treatments aimed at improving patients with PFPS have failed to provide consistent positive results. One out of four people are believed to experience PFPS at some point in their lifetime, making it the most common knee disorder treated in outpatient orthopedics.
Diagnosis of PFPS can be difficult, as there are multiple structures surrounding the patellofemoral joint that can cause pain. Of even more difficulty is figuring out the reason for the patient’s pain complaint, mostly when the pain comes on insidiously (for no apparent reason). Unless you fall on your kneecap, causing a traumatic arthritic response to your patellofemoral joint, most anterior knee pain complaints come on insidiously. So, why does your kneecap region hurt? This is the job of your physical therapist; to help you understand the underlying reasons for your patellofemoral joint pain.
During the initial evaluation, your physical therapist will ask detailed questions regarding your present symptoms and past medical history. For patients suffering from PFPS, your PT will be looking for clues such as past injury to your kneecap (trauma), past injury to your lower extremities (hips, knees, ankles, feet), and any history of low back pain or pelvic issues. Subjective complaints of pain with long-duration sitting with the knee bent, squatting, going down stairs, and pain during impact exercise (such as fast walking, running) is common with PFPS. Pain is typically described as being around the kneecap area (can be one-sided or diffuse), or retropatellar (under the kneecap).
The objective examination will look at walking patterns, standing habits, visual observation of your back/legs/feet, and also consist of functional tests to visualize your patterning during various activities and look to provoke your symptoms. The PT then assesses range of motion of your lower back and lower extremities (hips, knees, ankles/feet), looks at your core and lower extremity strength, muscle flexibility, ligament stability throughout the knee, and measures your leg length if indicated. Lastly, he/she will look at the joint mobility of your patellofemoral joint, palpate various structures around the kneecap, and look to provoke familiar symptom complaints helping to identify your painful structure.
Treatment of PFPS is multi-factorial. It includes detailed patient education of the clinical diagnosis, prognosis, patient expectations, the plan of care outlined by the PT, and the PT will look to answer any questions you may have about the injury and the process towards recovery.
Depending on the pain source and clinical diagnosis, physical therapy treatment will consist of manual therapy to improve joint mobility of the patellofemoral joint or lower extremity joints, lumbar spine mobilizations and/or manipulations, progressive functional core and lower extremity strengthening and stretching exercises, improvement of postural habits and activity modification as needed, and patient education for long-term self-management and continued progression outside of therapy.
At Life’s Work Physical Therapy (LWPT), our success rate in treating patients with knee conditions is significantly better than the national average. We believe in asking all the right questions and having an extensive, evidence-based, understanding of the best clinical practice guidelines for treating patients with knee pain. We understand the connections of the rest of the kinetic chain and its influences on the knee, looking to not only find out ‘what’ painful structure(s) are involved with your patellofemoral pain, but also figure out ‘why’ your knee is bothering you in the first place. Our dedication to life-long learning, and drive towards clinical expertise, keeps us cutting-edge in our industry, providing our patients with the best physical therapy possible.
If you are experiencing knee pain, which is affecting your ability to function at a high-level, contact Life’s Work Physical Therapy today for an evaluation. We look forward to seeing you in our clinic!