Patellofemoral pain syndrome refers to pain and discomfort at the patellofemoral surface. Also known as runner’s knee, the condition may affect both athletes and non-athletes. Abnormal patellar tracking during knee movements, quadriceps muscle imbalance, soft tissue tightness and poor lower limb biomechanics are predisposing factors for this condition.
The patient complains of diffuse pain around the patella (circle sign). There is localized pain emanating from behind the patella which may be accompanied by crepitus or the knee giving way while walking. Activities such as ascending or descending stairs, squatting, kneeling, cycling, running or prolonged sitting with knees bent (movie goer’s knee) increase the pain as the patella is pressed on the femoral condyles. Swelling is minimal.
The goal of physiotherapy treatment is to reduce pain and inflammation, restore joint range of motion, improve muscle strength and correct abnormal biomechanics.
NSAIDs, electrotherapy modalities like ultrasound, TENS, IFT or hot packs provide temporary relief in acute conditions but are seldom helpful in treating longstanding conditions.
Studies have shown that exercise therapy – quadriceps strengthening is the gold standard treatment for patellofemoral syndrome. Strengthening of vastus medialis through end range knee extension exercises helps to correct patellar tracking caused due to muscle imbalance. This needs to be supplemented by hamstrings, Iliotibial band and retinaculum stretching. Studies advocate strengthening of hip extensors, hip abductors and hip external rotators as well. McConnell’s taping to correct lateral patellar tilt and patellar shift can be done, however statistically there seems to be no difference in pain symptoms of taped and non-taped individuals. Knee bracing is another option though less effective. Pronated foot and related abnormal lower biomechanics can be corrected by providing medial arch support or custom orthotics to the foot.