TreatmentPrevention-Patellofemoral Pain Syndrome

Treatment Prevention-Patellofemoral Pain Syndrome
Posted on 05/12/2022

Treatment and Prevention of Patellofemoral Pain Syndrome

Madison England BS, LAT, ATC

Associate Athletic Trainer

Chaparral High School 

Highlands Ranch High School 


Patellofemoral Pain Syndrome (PFPS) is a condition of both malalignment and muscular dysfunction that causes pain surrounding the patellofemoral joint (Waryasz, Mcdermott, 2008). PFPS is the accepted term for localized pain on the anterior portion of the knee (Crossley, et.al., 2016). Typically, this condition presents as general knee pain that occurs with squatting, running, and climbing up and down stairs. PFPS is most common in the adolescent-athletic population. The foundational criteria of PFPS is pain behind the patella that is aggravated by activity that loads the patellofemoral joint during weight bearing activity with a bent knee. Other defining criteria that are not essential to PFPS can include grinding or crepitus (feeling crunchy) originating from the patellofemoral joint during movements that move the knee into flexion, tenderness upon patellar facet palpation, and mild effusion (swelling). Pain upon sitting, standing after sitting, or straightening the knee after sitting can also be present.  Knowing the anatomy and the involved structures can aid in identifying the cause of the pain and dysfunction. 

Orthopedic Surgery Diseaseļ¼šPatellofemoral Arthrosis | Treatment of disorder  | Tokushukai Group(Tokushukai Medical Group, n.d.)

Possible Causes 

There are various structures that can be involved with PFPS, and multiple diagnoses and previous injuries can contribute to PFPS. Foot disorders or deformities can cause PFPS  (Petersen, Rembitzki, Liebau, 2017). Also, altered foot mechanics during the gait cycle can be a factor that contributes to this condition. Laxity in the ligaments of the foot and ankle joints from previous ankle sprains may increase patellar mobility that can alter patellar tracking and lead to symptoms of PFPS. Any tilting of the patella can cause patellar hypomobility that increases stress between the posterior side of the patella and the patellar groove on the femur, resulting in PFPS. Quadriceps weakness is a significant cause of mal tracking and PFPS. 


Prevention and Treatment 

To reduce injury and time out of sport, some exercises should be implemented at home and at practice. This includes weight bearing exercises and non-weight bearing exercises. Before activity the athlete should start with a dynamic warm-up. Dynamic stretching promotes range of motion and flexibility and mimics the forces experienced during sport activity. At practice and in the weight room the athlete needs to ask for a demonstration and explanation of correct form. This will allow for proper muscle contraction and will ensure that the activity is being completed safely. If the athlete is not sure of a movement or exercise, the athletic trainer can provide a demonstration and explanation of the movement.  

In the athletic training room therapeutic exercises and modalities will be utilized to provide pain relief, and to correct movement patterns or muscle imbalances that could be causing PFPS. These exercises will include quadricep, hamstring, and hip exercises. The athletic trainer will also instruct the athlete on how to modify participation in sport and in the weight room. When the athlete is at home or is not able to go to the athletic training room there are some strategies that can be used to elevate pain and symptoms of PFPS. Icing for 20 minutes and 40 minutes of no ice, pain relievers (acetaminophen, ibuprofen, etc.) and completing exercise that the athletic trainer gave the athlete will decrease pain and allow the athlete to participate in their given sport.   


Resources:

Crossley, K. M., Stefanik, J. J., Selfe, J., Collins, N. J., Davis, I. S., Powers, C. M., … Callaghan, 

M. J. (2016). 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. British Journal of Sports Medicine, 50(14), 839–843. doi: 10.1136/bjsports-2016-096384

Michael A. Clark, B. G. (2014). NASM Essentials of Personal Fitness Training. Burlington: 

Jones & Bartlett Learning.

Petersen, W., Rembitzki, I., & Liebau, C. (2017). Patellofemoral pain in athletes. Open access 

Journal of Sports Medicine, 8, 143–154. doi:10.2147/OAJSM.S133406

Tokushukai Medical Group. (n.d.). Orthopedic surgery diseaseļ¼špatellofemoral arthrosis: 

Treatment of disorder. Tokushukai Group. Retrieved from https://www.tokushukai.or.jp/en/treatment/orthopedics/shitsugai-kansetsusyo.php 

Waryasz, G. R., & Mcdermott, A. Y. (2008). Patellofemoral pain syndrome (PFPS): a systematic 

review of anatomy and potential risk factors. Dynamic Medicine7(1). doi: 10.1186/1476-5918-7-9


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