Management of patellofemoral pain syndrome

Sameer Dixit, John P DiFiori, Monique Burton, Brandon Mines
American Family Physician 2007 January 15, 75 (2): 194-202
Patellofemoral pain syndrome (PFPS) is the most common cause of knee pain in the outpatient setting. It is caused by imbalances in the forces controlling patellar tracking during knee flexion and extension, particularly with overloading of the joint. Risk factors include overuse, trauma, muscle dysfunction, tight lateral restraints, patellar hypermobility, and poor quadriceps flexibility. Typical symptoms include pain behind or around the patella that is increased with running and activities that involve knee flexion. Findings in patients with PFPS range from limited patellar mobility to a hypermobile patella. To confirm the diagnosis, an examination of the knee focusing on the patella and surrounding structures is essential. For many patients with the clinical diagnosis of PFPS, imaging studies are not necessary before beginning treatment. Radiography is recommended in patients with a history of trauma or surgery, those with an effusion, those older than 50 years (to rule out osteoarthritis), and those whose pain does not improve with treatment. Recent research has shown that physical therapy is effective in treating PFPS. There is little evidence to support the routine use of knee braces or nonsteroidal anti-inflammatory drugs. Surgery should be considered only after failure of a comprehensive rehabilitation program. Educating patients about modification of risk factors is important in preventing recurrence.

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James Horrocks

In my considerable experience, both personally and professionally, my patients with medial tibia pain, usually improved with aggressive quadriceps stretching. Sports injuries are often a bit complex -- with more than one area of connective tissue too tight, too strong, too loose, and/or too weak. Nearly always, my patients did well by simply tightening what was too loose, loosening what was too tight, and correcting muscle-strength imbalances and/or weaknesses. (This is very pragmatic, I'll admit. But I would rather have a patient recover, without my clearly understanding the problem – – than understanding the problem well, but achieve no resolution of that problem.
James M Horrocks MD, FACP.


Thomas Parrish

Personally have dealt with this. It's amazing how quickly the pain resolves once you stretch and strengthen the leg. The major hurdle is getting those deconditioned to believe they do not need a pill.


Larry Brazley

I have found that athletic taping of the knee and patella has produced significant pain relief.


crol mac

And strengthening of the medial quadricep part, with reeducation of end of range extension, plus stengthining of exterorotators of the hip also help a hell of a lot.


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