This type of knee pain is usually felt of gradual onset in the front of the knee or behind the 'kneecap'. The knee will occasionally 'click' or 'clunk' while it moves through range. The knee will often ache with running, squatting, walking down stairs or sitting for long periods of time.
While physiotherapy is often used in managing this condition, its effects have not previously been established through research. A recent randomised controlled trial (ie: a reliable study) found that a Physiotherapy program for PFPS significantly decreased pain and improved function. This study provided scientific evidence for improved activation of the VMO muscle and the positive effects of Physiotherapy treatment in the management of PFPS.
Physiotherapy assessment is required to diagnose the injury and any contributing factors which may be causative of the injury:
• Postural misalignment
• Increased foot pronation
• Patella maltracking and lateral tilt
• Reduced VMO and quadriceps control
• Weak gluteus medius and gluteals
• Tight hip flexors
• Tight lateral structures (ie: tensor fascia latae (TFL), iliotibial band (ITB), hamstrings, lateral retinaculum)
Physiotherapy treatment may include:
1. Retraining of vastus medialis oblique (VMO), the small muscle bulk on the inside of the patella. The timing of this muscle with walking, running, jumping and landing activities is important in providing normal patella tracking. Specific exercises enable the VMO to contract with correct timing, improved control and strength.
2. Patella taping: this involves taping the patella to allow the VMO muscle to contract more effectively.
3. Patello-femoral joint mobilisations to reduce stiffness and inflammation behind the patella.
4. Lower limb stretches are also effective in restoring muscle balance around the knee.
5. Control exercises for the abdominals, pelvis and lower leg.
6. Massage to release tightness in the vastus lateralis and ITB that attaches to the lateral patella.
7. Advice on gradual return to pre-injury levels of activity is usually advisable following PFPS.