Patellofemoral pain syndrome

Do you notice knee pain when climbing stairs, after long periods of sitting or during sporting activities? Do you notice pain in the kneecap? Talk to your doctor. They might diagnose patellofemoral pain syndrome. Get an overview of the targeted treatment and find out how you can actively contribute to your therapy.

Patellofemoral pain syndrome

What is the patellofemoral pain syndrome (PFSS)?

The term patellofemoral pain syndrome (PFSS) is used to define pain in the patellar groove between the thigh and the kneecap. Patients with this syndrome mostly describe pain next to, behind or under the kneecap. This is why it is also commonly known as "anterior knee pain".

Patellofemoral pain syndrome is most prevalent among young women. This is because when the body is still developing, the muscles and bones very frequently do not grow at the same rate. Moreover, the increased prevalence of misalignments (knock knees), hormonal aspects and a reduction in physical activity also play a role.

Generally we distinguish between three degrees of instability: 

  • Lateralisation of the patella (the kneecap glides along the side of the patellar groove) 
  • Subluxation of the patella (the kneecap almost dislocates) 
  • Dislocation of the patella (the kneecap dislocates completely) 

The following synonyms are used for the patellofemoral pain syndrome (PFSS):

 

  • Femoropatellar pain syndrome (FPS)
  • Retropatellar pain
  • Patellar chondropathy
  • Patellar chondromalacia
  • Anterior knee pain

Causes of anterior knee pain

The most common causes include shortened or weakened thigh muscles, an incompletely formed kneecap groove, a leg axis deviation (such as knocked knees or bow legs) or even tilting of the kneecap.

In a healthy person, the kneecap sits in the so-called femoral groove like in a guide trough and it is also held in place by ligaments on each side. The muscles actively support the patella in gliding along the centre of the groove. If the kneecap is unstable, it no longer runs exactly in the femoral groove and, in the worst case, it "jumps" out of the guide trough. This is very painful.

Risk factors of patellofemoral pain syndrome

From the anatomical viewpoint, these include anomalies of the patellar groove or the shape of the patella. Other risk factors include a lax ligamentous apparatus (hypermobility of the kneecap), a high patella and an imbalance between the inner and the outer muscles over the front of the thigh. The latter condition can lead to a situation, in which the shortened muscles pull the kneecap to the side over the tendons.  The result: instability of the kneecap.

Signs and symptoms that can cause an unstable kneecap

The pain is felt behind, next to or under the kneecap. Symptoms onset above all after long periods of sitting or resting the knee joint (start-up pain), but also in connection with sporting activities or when climbing stairs.

Trigger points: When pain radiates

Healthy muscles contract and relax again. Overstrain can lead to the outer thigh muscle first contracting permanently and then shortening. This can result in the formation of "trigger points" that cause local and radiating pain. Thus symptoms in the knee can also be associated with the formation of a trigger point in the outer muscles over the front of the thigh.

Treatment of anterior knee pain

Most cases of lateralisation or subluxation of the kneecap are treated conservatively, i.e. without an operation. The patient wears a knee support or a knee orthosis (for dislocation) to stabilise the kneecap and the knee joint. If the kneecap dislocates once or even several times, an operation may be considered. It is also important to correct the direction of pull on the kneecap. Physiotherapy exercises and regular training on your own, help to strengthen the muscles over the front of the thigh. 

Patellofemoral pain syndrome: Therapy-supporting physiotherapy exercises

With the right exercises, you can stay fit and mobile and prevent pain. In particular, you should strengthen the muscles over the front of your thigh with regular training sessions on your own, which will have a positive influence on the direction of pull on the kneecap.

The training programme consists of exercises to warm up, strengthen the front thigh muscles, stabilise the leg axis, activate the hip abductors, and stretch the thigh muscles. First consult your doctor or therapist to see whether the exercises are suitable for you.

Leg pendulum in a sitting position

Dynamic squat

Aim: Strengthening the anterior thigh muscles (quadriceps)

Starting position

  • Slide the loop around the front leg of the table
  • Sit on the table and place your ankle in the loop
  • Bend your legs until they form a 90° angle, pointing your toes forwards

Exercise

  • Stretch your leg by the length of a shoe and then straighten it out again

Note: Perform the exercise in a slow and controlled manner.

Dosage

  • 3 sets, 15 reps each

Knee flexes – with loop

Aim: Strengthening the anterior thigh muscles (quadriceps) and activating the hip abductors

Starting position

  • Place the loop around the legs above the knees
  • Stand with your feet shoulder-width apart
  • Keeping your torso straight

Exercise

  • Push your buttocks out behind you and go into a squat position
  • While doing so, push your knees outwards against the resistance of the loops
  • Return to the starting position

Note: Perform the exercise in a slow and controlled manner. Make sure to maintain the tension in your torso throughout. Keep your upper body straight. Keep your heels planted on the floor.

Dosage

  • 3 sets, 15 reps each

Knee flexes – with ball

Aim: Strengthening the anterior thigh muscles (quadriceps) and activating the hip adductors

Starting position

  • Stand upright
  • Place a ball (alternative: a cushion) between your legs at knee height

Exercise

  • Push your buttocks out behind you and go into a squat position

Note: Keep your torso straight. Keep your heels planted on the floor. Perform the exercise in a slow and controlled manner. Make sure to maintain the tension in your torso throughout.

Dosage

  • 3 sets, 15 reps each

Knee extensor with loop

Aim: Strengthening the anterior thigh muscles (quadriceps)

Starting position

  • Slide the loop around the front leg of the table
  • Sit on the table and place your ankle in the loop
  • Bend your legs until they form a 90° angle, pointing your toes forwards

Exercise

  • Stretch your leg by the length of a shoe and then straighten it out again

Note: Perform the exercise in a slow and controlled manner.

Dosage

  • 3 sets, 15 reps each

Stretching in a lying position

Aim: Stretching the anterior thigh muscles (quadriceps)

Starting position

  • Lie on your side with the leg you wish to train on top
  • Now bend the lower leg forwards into a 90° angle

Exercise

  • Bend the upper leg backwards
  • Hold your foot in your hand and bring your heel up towards your buttocks until you can feel the stretch in your anterior thigh muscles

Dosage

  • 3 sets, 45 seconds hold each
  • Relaxing in between

Information material for download:

Patellofemoral pain syndrome: Orthoses from medi

Therapy for patellofemoral pain syndrome is primarily carried out using conservative approaches, i.e. non-surgical methods. Orthoses such as the Genumedi PT have proven to be effective. It can stabilise the knee joint and improve the range of motion in the kneecap, and so counteract patellofemoral pain syndrome.

Restoration of the muscular equilibrium

A: Reduction of the tension in the outer section of the thigh musculature and activating specific trigger points
Using a belt to adjust the pressure applied to your liking

B: Activation of the weakened muscle sections

C: Stable range of motion in the kneecap

Click here for more information about the Genumedi PT knee orthoses.

 

Health personnel will make the diagnosis and can prescribe medical aids, e.g. from medi if necessary.

Your medical retailer will fit them individually for you.