Patellofemoral Pain Syndrome, otherwise known as a painful kneecap, affects 25% of the population, according to the Academy of Orthopaedic Physical Therapy. Unfortunately, women tend to be twice as affected as their male counterparts! It is often described as a nagging ache or an occasional sharp twinge in the front of the knee. It is often worse after sitting for extended periods, going up and down stairs, jumping or running, especially on hills.
Some new insight has been developed in a first ever comprehensive clinical practice guideline on patellofemoral pain (PFP). The APTA’s Academy of Orthopaedic Physical Therapy conducted an extensive review of scientific articles associated with PFP from 1960-2018. They evaluated the overall strength of the scientific evidence regarding the diagnosis, examination and interventions in the management of PFP. They found strong evidence supporting exercise therapy with combined hip and knee targeted exercises to reduce pain and improve overall function. They found that the combined hip and knee targeted exercises were far better than knee focused exercises alone. These new guidelines stress that exercise therapy is the best approach to improve functional performance in the short, medium and long-term management of knee pain.
The guidelines also found that the use of dry needling, ultrasound, electrical stimulation, laser treatments and bracing were not greatly supported. They did find that taping techniques were supported by moderate level evidence, especially in the first 4 weeks of pain management and only in combination with exercise therapy. Off the shelf shoe inserts for patients with overpronation were shown to be beneficial during the initial 6 weeks of management. There was insufficient evidence to support the recommendation of custom foot orthoses over prefabricated ones.
A holistic approach that combines education, strength training exercises for the posterior hip and knee musculature, taping, shoe inserts and kneecap mobilizations are likely to bring the best results. Specific patient education on gait mechanics, knee loading management, body weight management and biomechanics that may contribute to overloading the patellofemoral joint, may improve compliance and self-management strategies. To help guide your treatment and tailor a program to fit your needs, our physiotherapists can evaluate your symptoms, movement patterns and biomechanics to help you return to your desired activities, sports or work. We aim to keep you moving!
Jennifer Gordon (BSc.PT, AFCI, GIMS)