Knee cap or patellofemoral pain syndrome explained

Have you had knee cap pain that just needed a couple of days rest? Lots of acute injuries will resolve on their own, but new evidence is showing this may not be the case with patellofemoral pain.

Although there are definite gaps in our knowledge of this condition, there are many treatment options that can be very beneficial.

Pain under the knee cap is best treated early as there are strategies that can be implemented to reduce pain and enhance recovery.

Our goal in this post is to give you the most up to date information on patellofemoral pain.

What is ‘patellofemoral pain’

Person holding their knee in pain. Black and white image. Click Physiotherapy

Patellofemoral pain, also known as anterior knee pain syndrome, is a vague term used to describe pain around or behind the knee cap. It is also one of the most common causes of front knee pain for people under 60.

Medical professionals can diagnose patellofemoral pain by asking about the location of symptoms, and also testing for pain in the knee with activities like squatting or kneeling. Pain in the front of the knee after sitting for prolonged periods is another indicator of patellofemoral knee pain.

No investigations such as x-rays are required to diagnose patellofemoral pain, however these can be good to exclude other conditions like knee osteoarthritis or osteochondritis.

The big problem with Patellofemoral Pain Syndrome?

It used to be though that this condition would eventually fix itself, like some other knee injuries.

More research in the field is challenging this assumption and this condition may not get better on its own. In fact, this condition has the potential to stay over your lifetime and could eventually link with arthritis under the kneecap.

That is why it’s important to recognise symptoms earlier rather than later and seek appropriate treatment.

How is patellofemoral pain syndrome treated?

When treating patellofemoral pain, the evidence will suggest adopting a shotgun approach. It’s more effective to target both hip strength and leg strength than just focusing on the quads.

If possible, you will need to reduce the load going through your knee. Orthotics can be beneficial for a couple of months pain relief, whilst you get your exercise routine sorted.

Strengthening the leg

As mentioned earlier there are many exercises which will help to target anterior knee pain. It is highly encouraged to stay motivated and trial a good period of time where you are strengthening your lower limbs.

Our advice would be to work on hamstring and gluteal strength, then move towards targeting the thigh muscles when the pain isn’t as extreme.

One warm-up exercise that works extremely well for activating your side hip muscles is demonstrated in the below video. This exercise will focus on your Gluteus Medius which helps to stabilise your hips when you stand on one leg.

After you have begun hip strengthening you can begin strengthening your quadriceps, which are your front thigh muscles. These are the most important to target as they attach directly onto the kneecap and will usually be weak with patellofemoral pain syndrome.

There are many ways to strengthen the quadriceps. Squats and step-ups can be good exercises, however early on this might aggravate your anterior knee pain. For this reason a seated knee extension with resistance might be a better starting choice.

Look at the video below to find out exactly how to perform this exercise.

Reducing the load

The key to managing patellofemoral pain syndrome is to decrease the load going through the front of the knee. There are certain activities which load the knee more than others.

Deep squatting is certainly one culprit where there is increased load. If you love squatting and suffer patellofemoral pain, then we would recommend you try front squats. This will help reduce some load on the knee.

Sport can be hard on those joints as well, and unfortunately, we all love it! Sport is important and good for you, but if this knee pain is limiting you, there are certain sports that may suit better than others.

It would be prudent to avoid sports that include excessive jumping or running/cutting across hard surfaces as these will load up that knee joint. These sports include volleyball, netball, basketball etc.

Other sports, like ones on a field, at least have some cushioning for the knees. Alternatively, you could become the next Australian swimmer gold medallist!

Will custom orthotics help?

Custom orthotics don’t work any better that your off-the-shelf orthotics from the shops. We know that if it fits and is comfortable, then it has the same chance of working as any custom orthotics! You can thank us later for saving you $600+.

Conclusion

Patellofemoral pain syndrome needs to be treated and it will take work until you see results. Click Physiotherapy is more than equipped to help you on this journey if you need that extra hand. Remember this pain won’t fix itself so stay on top of it!

To book an appointment today click here.

References

Barton CJ, Lack S, Hemmings S, et al The Best Practice Guide to Conservative Management of Patellofemoral Pain: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med 2015;49:923-934.

Crossley KM, van Middelkoop M, Callaghan MJ, et al 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions) Br J Sports Med 2016;50:844-852.

Crossley KM, Is patellofemoral osteoarthritis a common sequela of patellofemoral pain? (2014) British Journal of Sports Medicine 48:409-410

Gaitonde, D. Y., Ericksen, A., & Robbins, R. C. (2019). Patellofemoral Pain Syndrome. American family physician99(2), 88–94.