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Refreshing Lens for the Management of Patellofemoral Pain

Patellofemoral pain syndrome (PFPS), also known as "runner's knee," is a common condition characterized by pain around or behind the kneecap (patella). It affects people of all ages and activity levels, not just runners. 


PFPS is defined as pain around or behind the patella, which is aggravated by at least one activity that loads the patellofemoral joint during weight bearing on a flexed knee. 


Causes and Risk Factors 

PFPS can result from various factors, including: 

- Overuse or repetitive stress on the knee joint, often seen in activities like running, jumping, or squatting. 

- Muscle imbalances or weaknesses, particularly in the quadriceps and hip muscles, leading to improper tracking of the patella. 

- Structural abnormalities, such as patellar malalignment, excessive foot pronation, or leg length discrepancies. 

- Sudden increases in physical activity or training intensity. 

Women, adolescents, and young adults are more susceptible to developing PFPS. 



The primary symptom of PFPS is dull, aching pain around or behind the patella, which can worsen with activities that involve bending the knee, such as climbing stairs, squatting, or sitting for prolonged periods. Other symptoms may include: 

- Cracking or popping sounds when bending the knee 

- Stiffness or swelling around the knee joint 

- Difficulty fully straightening or bending the knee 


Treatment and Management 

PFPS is typically treated conservatively, with a combination of the following approaches: 

- Activity modification and rest to reduce stress on the knee joint 

- Strengthening exercises for the quadriceps, hip abductors, and other stabilizing muscles 

- Stretching and flexibility exercises for tight muscles 

- Patellar taping or bracing to improve patellar tracking 

- Proper footwear and orthotics to correct biomechanical issues 

- Physical therapy to address muscle imbalances, improve flexibility, and correct faulty movement patterns 


When it comes to treating PFPS, it is important to account for the loading of the joint and how that loading occurs during painful activities. What this means is sometimes the problem isn’t actually in the knee, but rather the ankle or hips (or another joint/muscle group in the body) that are placing the knee in improper positioning, thus generating odd/maladaptive loading forces. How we treat your patellofemoral pain will be directly tailored to how you are loading it; whether it’s over-loaded, under-loaded and has lost the tolerance to load, or the angles of the load are “off.”  


In severe or persistent cases, surgical intervention may be considered to address structural abnormalities or remove damaged cartilage. 


Patellofemoral pain syndrome is a common condition that can significantly impact daily activities and physical performance. Early recognition and proper management, including targeted exercises and activity modifications, can help alleviate symptoms and prevent further complications. 


Info pulled from continuing education at the APTA Combined Sections Meeting 2024 in Boston, MA. Presenter was: Gretchen B. Salsich, PT, PhD 


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