What is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome is also known as runner’s knee, PFJ pain, patellar mal-tracking or anterior kneecap pain.

It is the most common running injury but also heavily affects cyclists, gym goers and people doing running based sports such as football or netball.

The pain is usually felt in the front of the kneecap or underneath the kneecap, as the picture above indicates. The pain will get worse with more activity or in deeper bending/squatting positions.

Sufferers may have pain sitting, going up and down stairs or have pain after exercise.

What causes Patellofemoral pain syndrome?

The knee joint is made up of 3 articulating surfaces: the thigh bone (femur) resting on top of the shin bone (tibia) and the kneecap (patella) sitting in the groove of the thigh bone.

As we bend and straighten the knee, the kneecap moves up and down this groove within the tendon attaching the thigh muscle (quadriceps) to the shin bone.

The articulating surfaces between the kneecap and thigh bone can become irritated and cause pain in the front of the knee and this is called Patellofemoral Joint Pain Syndrome.

All sporting induced patellofemoral joint pain is caused by training error. There is too much activity in too short an amount of time where the knee has not had a chance to adapt to the loads.

In non-sporting populations PFJ pain may be caused by cartilage injuries (generally in younger sporting populations who have suffered an acute/traumatic incident) or from osteoarthritis symptoms (generally in older populations).

The acute pain caused by irritation and inflammation can initially be settled down with relative rest, ice, anti-inflammatories and taping. However it is important to identify the underlying cause of the irritation so that it may be addressed. Otherwise the irritation will continue to arise with load.

Common contributing factors include:

Training errors and poor load management
Weakness or underutilization in some muscles, particularly glutes/hip stabilisers
Poor movement patterns or running technique, particularly excessive heel striking or over striding
Tightness in some muscles, particularly the ITB/TFL or adductors

Do I have Patella Tendinopathy or Patellar Tendonitis?

Patella tendinopathy (also called patellar tendonitis, patellar tendinosis, jumper’s knee) is an overload injury to the patella tendon.

This injury is different to PFJ pain as patella tendinopathy is much more specific, where pain is exactly on the patella tendon and does not radiate around the general kneecap. If you suffer from a patella tendinopathy you can point to the exact point of pain with 1 finger, right underneath the kneecap. Refer to the picture above to where patella tendinopathy pain occurs.

Patella tendinopathy occurs due to an overload of plyometric loads. It is seen in jumping athletes (basketball, triple/long jump, high jump etc) and occasionally in change of direction athletes (soccer, football, netball etc). It is extremely rare to get a patella tendinopathy from distance running.

Patella tendinopathy physiotherapy is very different to PFJ. It is important that a correct diagnosis is made early. Sometimes chondromalacia patellae may be present, though this may not be causing symptoms.

How to treat Patellofemoral pain syndrome and when to see a Physiotherapist?

If you have been experiencing knee pain as described above for >1 week, you should seek treatment. Your physiotherapist will assist you to reduce the acute pain as well as identifying the relevant contributing factors to your pain.

Physiotherapy may involve taping and/or medication/anti-inflammatory recommendations from a GP to reduce the initial pain.

A reduction in activity is vital to allow the irritated joint to build up its capacity. FULL REST is not recommended, as it deconditions the body and legs too much. A physiotherapist will be able to manage training loads to keep you as active as your body allows. A running program may be prescribed to gradually introduce more running into the knees.

Once the pain is at a controlled level, a vital component of physiotherapy will involve strengthening exercises for the patellofemoral joint. A strength assessment will be undertaken to determine if there is any contributing weakness in the calves, glutes, hamstring or quad muscles. And these muscles will be adequately strengthened with the aim to be doing single leg strength exercises. Your physio will determine testing outcomes for you to return to sport running (eg 20 sit to stands from a chair, 25 calf raises etc).

If biomechanics are thought to be a contributing factor, running drills and technique prompts may be prescribed. Increasing cadence, emphasising a lighter landing and temporarily transitioning to less of a hindfoot heel strike may be used initially and has been shown to decrease PFJ pain.

Once pain and strength has improved, the next step is to gradually wean up running and sport to your goal levels. Training intensity, frequency and duration will all be considered to get you back to your ideal level!

Melbourne Sports Physiotherapy

Melbourne Sports Physio has a range of qualified and experienced professionals who can help provide ongoing support and treatment. Our friendly team are located in across Melbourne in Essendon, North Melbourne and Blackburn South, and appointments can be made by calling or booking online.

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