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Patellofemoral Pain Syndrome

First off, please visit the general knee pain page for some info!

What it IS

While many runners who experience any sort of knee pain may suggest they have “runner’s knee”, patellar-femoral pain syndrome is actually Runner’s Knee. PFPS is an ache or pain behind or around the top of the kneecap. 

What is Patellofemoral Pain Syndrome?

From Sports Injury

PFPS occurs when the patella (kneecap) rubs on the femur bone underneath. It is often thought that incorrect tracking or rubbing of the patella over the femur bone is a significant factor and results in damage or irritation of the articular cartilage underneath the patella.

Patellofemoral pain is common in people who do a lot of sport and in particular adolescent girls. It can have a number of causes but damage to the cartilage itself cannot directly cause pain because there are no blood vessels or nerves involved. However it can lead onto other problems which in turn result in pain. These include synovitis (inflammation of the synovial membrane or joint lining), erosion of the cartilage and bone under the patella, soft tissues injury or irritation for example to the lateral retinaculum and the infra patella fat pad.

The initial cause of patellofemoral pain syndrome is likely to be overuse. This may be from external factors for example a sudden increase in training, or performing high intensity jumping and knee bending, or it can be from internal factors such as poor patella tracking. Identifying the cause is and important part of treatment.

How to Treat PFPS

When you’re in the middle of experiencing this discomfort, using heat can help. Michael Conlon, owner of Finish Line Physical Therapy in New York City suggests “If you don’t have severe acute pain, steer clear of icing. Cold restricts blood flow, which you need for tissue to repair itself. Heat, such as warm baths or heating pads, are a better idea.  

As with most injuries somehow linked to training load errors and muscle/tissue weaknesses, rehab is going to be a combination of rest to allow the tissues to regenerate + practicing some general strength and mobility for increasing blood flow, strengthening the body, and preventing future recurrences.

I suggest visiting my strength routine page for a number of videos that walk you through some superb bodyweight routines targeting the hip and legs. These should be done 3x weekly at the minimum! If you’re reading this article, I hope you take your injury as motivation to get on track with doing this! 

A stretching and foam rolling protocol can be a nice ancillary activity to the strengthening routines, as well!

Studies, Quotes, and Further Reading

Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain?A randomised clinical trial | British Journal of Sports Medicine | “Even though gait retraining and exercises improved their targeted mechanisms, their addition to education did not provide additional benefits on symptoms and functional limitations. Appropriate education on symptoms and management of training loads should be included as a primary component of treatment in runners with PFP.”

Why treating Runner’s knee can be a simple fix. | Alex Hutchinson | “We were pretty sure that the addition of exercise or gait training would provide better outcomes,” Esculier says. “But none of that happened.”​​

Females with patellofemoral pain syndrome have weak hip muscles: a systematic review | Australian Journal of Physiology | Females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy controls.

Exercise for treating patellofemoral pain syndrome | Cochrane Database for Systematic Reviews | “There is some very low quality evidence that hip plus knee exercises may be more effective in reducing pain than knee exercise alone.”