Patellofemoral pain syndrome

Patellofemoral pain syndrome (PFPS) is the name for a knee condition where you get pain at the front of your knee. It may be behind or around your kneecap (patella). It’s thought to happen because of stress on the joint between your kneecap and your thigh bone (femur).

About patellofemoral pain syndrome

Patellofemoral pain syndrome is one of the most common causes of knee pain. Although anyone can get it, it’s more common in women, and in people in their twenties and thirties. Patellofemoral pain syndrome is sometimes called ‘runner’s knee’ because it’s particularly common in people who run. But you can get it doing other sports too.

Causes of patellofemoral pain syndrome

The exact reasons why you can develop patellofemoral pain syndrome aren’t known. But it’s probably caused by a combination of things. It often develops as a result of overuse – for instance, if you have repeated stress on your knee during sports. It can also be triggered by a sudden change in how often you exercise or how long you exercise for.

You’re more likely to get patellofemoral pain syndrome if there’s a structural problem that affects the joint between your kneecap and thigh bone. This can include minor problems in the alignment of your knee joint and weakness in the muscles around your hip or thigh. These problems can affect the way your knee joint moves, and can cause pain.

Symptoms of patellofemoral pain syndrome

Patellofemoral pain syndrome can affect one or both of your knees. The main patellofemoral pain syndrome symptom is a dull, aching pain, which you feel around and in front of your knee or at the back of your kneecap. The pain can also feel sharp. The pain will usually start gradually and get worse if you do a lot of activity.

The pain may be especially bad when doing activities where you need to bend your knee. Such activities include going up and down stairs or doing squats. You may get pain when you sit with your knees bent for a long time.

You may also get crackling or crunching sounds in your knee when you bend or straighten it.

Self-help for patellofemoral pain syndrome

Patellofemoral pain syndrome self-care is important. You’ll need to reduce the amount of activity you do that causes you pain. For example, if you’re a runner, you might reduce the amount of running you do. Alternatively, you could change the type of activity. You could maintain your fitness with exercises such as swimming and cycling that put less stress on your knee.

If you have any swelling, put an ice compress on your knee. Leave it on your knee for 10 to 15 minutes at a time, two to three times a day. This may be especially helpful after you’ve been active. But don’t put ice directly on your skin because it can burn your skin – place a cloth between the ice and your skin.

Treatments for patellofemoral pain syndrome

The initial patellofemoral pain syndrome treatment is to tackle your pain. You can do this by reducing any activities that cause pain and using ice to reduce pain and inflammation (see our section on self-help). Medicines will also help to reduce pain and inflammation. Further treatment includes stretching and strengthening exercises with physiotherapy to gradually get you back to your usual activities.

The patellofemoral pain syndrome recovery time for most people is about four to six weeks.

You may find it helpful to see a sports medicine professional such as a physiotherapist or a sports doctor. An orthopaedic doctor is a doctor who specialises in bone conditions. Your GP may be able to refer you to a physiotherapist or an orthopaedic doctor, or you can book an appointment with a physiotherapist yourself.

Medicines for patellofemoral pain syndrome

You can buy non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or other painkillers over the counter. These may provide short-term pain relief of patellofemoral pain. If your pain is really bad, your GP may be able to prescribe stronger NSAIDs if you need them. Always read the patient information that comes with your medicine, and if you have questions ask your pharmacist or GP for advice.

Physiotherapy for patellofemoral pain syndrome

Your physiotherapist will carefully assess your knee, and then plan an individual programme of patellofemoral pain syndrome exercises. These will help strengthen your knee and leg muscles. The exercises may include stretching and specific strengthening exercises as well as exercises to improve the range of motion of your knee. Make sure you do these exercises because they’re an important part of your recovery.

Other treatments your physio may suggest include the following.

• Manual therapies, such as massage or manipulation of your knee joint may help improve your symptoms.
• Wearing inserts in your shoes (orthoses) may help to reduce pain and improve function. You can buy these from a pharmacy or online. Your physiotherapist can advise you on what to buy or may refer you to see a podiatrist to have them fitted.
• Taping your knee before you do your exercises or wearing a support brace may help with pain. It’s unclear how effective these supports are – but they seem to be helpful for some people.

Surgery for patellofemoral pain syndrome

People with patellofemoral pain syndrome rarely need surgery. But it may be an option if you have severe, persistent pain, and other treatments haven’t worked.