Patellofemoral Pain Syndrome: What Is It?

Recently, I've been asked a few times about Patellofemoral Pain Syndrome (PFPS) as well as a few clients walk into my office with complaints of knee pain so I thought I'd put together some information to try to clarify some of the issues related to this common ailment.

A quick Google search of 'Patellofemoral Pain Syndrome' provides you with almost 350,000 results and after this post, you'll be able to add another one to that list.  Try many of the other iterations like PFPS, patellofemoral pain, patellofemoral syndrome, runner's knee, chondromalacia patella, movie-goers knee, etc. and you'll come up with thousands more.  So what does this all mean?  Well it means there is a ton of information (and misinformation) about one of, if not, the most common knee injuries to plague athletes, weekend warriors, office workers, young, old...just about anyone.

The first goal is to define what it is.  The simple version is pain around and/or behind the kneecap (patella) as it articulates or touches the femur.  That sounds pretty straightforward but it can present itself in a variety of ways which is why you will find so many definitions/results with a Google search and among healthcare practitioners.  It is also part of the reason why it has been given the vague designation of a 'syndrome'.  The truth of the matter is nobody knows exactly what causes it or what is happening at the patellofemoral joint when PFPS shows up to the party.  All we know is that the end result is pain.  Since there is no consensus on what is actually happening, that makes finding a solution more challenging than say a broken bone or muscle strain.  Add other knee injuries that can be confused with PFPS like iliotibial band syndrome (ITBS, yet another syndrome and another post), patellar tendonitis and bursitis and one can see how a 'simple' definition can become a complicated issue to diagnose and resolve.

Though quite varied from person to person, there are some hallmark symptoms, however, that can help narrow down the differential diagnosis.  These commonly include, but are not limited to, pain with squatting, ascending/descending stairs, running and prolonged sitting.  Sometimes joint effusion or swelling will be present but again, this is quite variable also.  Granted, these are common complaints among other knee injuries as well so PFPS often becomes a diagnosis of exclusion due to signs, tests and subjective complaints that can help distinguish between issues like meniscus pathology, tendonitis, bursitis, ITBS, etc.

Now this is where physical therapists make the 'big bucks' (I can dream, right?).  It is nice to have someone walk into my office with cookie cutter complaints so that the solution is easy but honestly, that situation doesn't happen very often.  Instead, I am able to use my training and knowledge in anatomy, kinesiology and biomechanics, muscle physiology, neuroscience and psychology to assess the incredibly dynamic system that is the human body and brain to formulate a conclusion as to why someone is experiencing pain, in this case patellofemoral pain.  Through careful observation, specific tests and measures, and most importantly, listening to my clients, I can deduce the driving factors of someone's patellofemoral pain and customize a plan to resolve his/her pain and limitations.  Quite often, there are multiple factors involved and it is my job to determine the best way to address them and sequence the plan to get my clients back to moving better, feeling better and living better.

Stay tuned for my next post to learn about some of the ways patellofemoral pain syndrome can be resolved.

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