Treating Patellofemoral Pain Syndrome

One of the common knee complaints encountered in athletes (and other individuals) is patellofemoral pain syndrome. It is a difficult pathology to treat successfully with permanent results.

While not completely agreed upon, it is thought that the cause for PFPS is a combination of the reaction force and the contact area. With the alignment of the proximal attachment of the quadriceps and the distal attachment of the patellar ligament, there is a lateral pulling force (the Q-angle) that compresses the patella against the lateral femoral articular surface.

There have been many suggestions on how to treat patients with this diagnosis. One common method, focuses on decreasing the effect of the valgus force at the knee by strengthening the hip external rotators and extensors. By decreasing the valgus forces, there is theoretically less compression on the lateral side of the patellofemoral joint.

There have also been studies on strengthening the quadriceps muscles with reported success. In the study, both closed-chain and open-chain exercises were used with improvement in function and pain.

Some alternate methods that can be included in treating PFPS are taping  of the patellofemoral joint and utilizing orthotics. While there has not been much evidence in using orthotics, if the patient is reporting a decrease in pain with use, it would not hurt for them to keep using the device. Taping, on the other hand, has shown to have success in improving pain and function when combined with exercise. The study looked at here utilized a program with 2 initial weeks of taping followed by exercise that had successful long-term outcomes.

A final study we looked at was exercise vs. exercise and knee arthroscopy. Both immediate and 5-year follow-up reported improvements in pain and function; however, there was no significant difference between the two groups, suggesting that surgery may not be necessary for all individuals.

From reviewing these articles, we like to try and take a conservative approach initially with patients of PFPS by including taping, exercises that strengthen the quads and hip external rotators/extensors, and possibly orthotics. Of course, consider using additional exercises and stretches with these patients, but surgery may not be the option for everyone. Check out the articles to decide for yourselves!

References:
Bolgla LA, Boling MC. "An update for the conservative management of patellofemoral pain syndrome: a systematic review of the literature from 2000-2010." Int J Sports Phys Ther. 2011 Jun;6(2):112-25. Web. 09/02/2012.

Kettunen JA, Harilainen A, Sandelin J, Schlenzka D, Hietaniemi K, Seitsalo S, Malmivaara A, Kujala UM. "Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized control trial." Br J Sports Med. 2012 Mar;46(4):243-6. Epub 2011 Feb 25. Web. 09/02/2012.

Khayambashi K, Mohammadkhani Z, Ghaznavi K, Lyle MA, Powers CM. "The effect of isolated hip abductor and external rotator muscle strengthening on pain, health status, and hip strength in females with patellofemoral pain: a randomized control trial." J Orthop Sports Phys Ther. 2012 Jan;42(1):22-9. Epub 2011 Oct 25. Web. 09/02/2012.

Paoloni M, Fratocchi G, Mangone M, Murgia M, Santilli V, Cacchio A. "Long term efficacy of a short period of taping followed by an exercise program in a cohort of patients with patellofemoral pain syndrome." Clin Rheumatol. 2012 Mar;31(3):535-9. Epub 2011 Nov 3. Web. 09/02/2012.

Swart NM, van Linschoten R, Bierma-Zeinstra SM, van Middelkoop M. "The additional effect of orthotic devices on exercise therapy for patients with patellofemoral pain syndrome: a systematic review." Br J Sports Med. 2012 Jun;46(8):570-7. Epub 2011 Mar 14. Web. 09/02/2012.