Patellofemoral Pain Syndrome: Symptoms and Treatment

Patellofemoral Pain Syndrome (hereafter referred to as PFS) has many causes and can really be a hassle to deal with if you don’t recognize the symptoms early.

Signs and Symptoms

The signs and symptoms of PFS are mostly focused on pain: where it’s located and what increases it.

Pain can be located in a wide variety of places, including:

• The anterior portion of the patella
• The posterior portion of the patella
• The edges of the patella (any side)
• Radiating medially or laterally from the patella

The most common location of pain and other symptoms is on the anterior aspect of the knee.

Pain usually starts or is increased with:

• Prolonged sitting
• Weight-bearing
• Standing up from a squatted position (including standing up from a chair)
• Kneeling
• The landing phase of a jump
• Going up or down stairs (down usually hurts worse)
• Active and resisted (like using a knee extension weight machine) knee extension
• End-range passive knee flexion (using your hand to pull your heel up to your butt)

Pain often continues into the evening and night even after ending pain-inducing activities.

Other signs and symptoms include:

• Tenderness of the lateral side of the patella
• Swelling near the patella and/or anterior of the knee
• Feeling a dull ache in the center of the knee (feeling like your pain is inside your knee, as opposed to being right under the surface of the skin)
• Crackling or grinding sensation when the kneecap is compressed against the femur (either by you pushing on it or during activities like kneeling, descending stairs, etc.)
• Stiffness after periods of immobility, especially long periods of sitting without moving your leg

At-home Treatment

***Be sure to see the section below about deciding when to go see the doctor.***
Pain at the patellofemoral joint can often mimic the symptoms of meniscal trauma. Be certain that your pain is not caused by a meniscus tear before attempting to treat yourself.

Basic treatment of PFS is split into 2 parts: palliative treatments and corrective exercises.  Palliative means ‘relieving without curing’, so these treatments are designed to simply make you feel better by reducing your symptoms (most notably, pain).

Palliative Treatment

PFS symptoms will go away if you rest. But, if you don’t fix the cause (improper mechanics, weak muscles), the pain will return when you return to activity (this can even include things like stairs or standing up from a chair, not just working out, jumping, dancing, or running).

The first step in palliative treatment of PFS is to modify activity by avoiding pain-producing activities. However, this does not mean that you should start limping. Limping can cause all sorts of other problems throughout both legs and your lower back.

The other ways to relieve your symptoms are to ice, wear a J-Brace (if you need/want to), and take anti-inflammatories, like Ibuprofen, Advil, Aleve, and Motrin (but not Tylenol – it’s not an anti-inflammatory). Be sure to follow the dosing instructions on the label whenever you take medication.

Corrective Exercises

As with any medical ailment, if you treat the symptoms of PFS without correcting the cause, your symptoms are going to come back as soon as you get back to whatever it was that caused your pain in the first place. Treatment for your symptoms will help you feel better. Corrective stretches and exercises will help you stay that way. If you’re able to figure out what caused your PFS symptoms, you need to focus your treatment efforts on eliminating these causes.

The most important thing to remember when doing corrective exercises for PFS is that none of your exercises should cause pain. The primary goals of corrective exercises and stretches for PFS are to:

1. improve the flexibility of tight musculature in the lower extremity
2. strengthen weak muscles in an effort to correct muscular imbalances in the lower extremity
3. improve or correct improper mechanics during exercises and movement, especially loaded knee flexion (squatting)

In order to correct most causes of PFS, the vastus medialis oblique (VMO), one of the quadriceps muscles, needs to be strengthened. Any knee extension exercise that causes this muscle to contract is a good exercise to include in a PFS treatment plan.

Lastly, orthotics can help correct poor alignment and improper patellar tracking, and they can make it easier for you to change your improper movement patterns (mechanics).

When to See a Doctor

You need to see a physician if:

• Your pain gets worse or doesn’t improve after rest
• You feel like your kneecap is dislocating
• You have tenderness directly over the joint line of your knee (the part of your body between your tibia and your femur all the way around your leg)
• You have a locking sensation in your knee when you move it (even if it’s only occasional) – this is different from a clicking noise
• You have pain directly over your kneecap and your kneecap is tender when you push on it
• You experience new knee pain (during your injury recovery) following a traumatic injuring event, such as a fall, twist of the knee, direct blow (being hit by someone or something on your knee)
• Your knee buckles or gives out when you try to put weight on it
• Your knee is so swollen that you can’t fully bend or straighten it