CPD Task 2 (1 Hour)
Patellofemoral Pain Syndrome (PFPS):
PFPS is an umbrella term used for pain arising from the patellofemoral joint itself, or adjacent soft tissues. Historically it has been referred to as anterior knee pain, but this is misleading as the pain can be felt in all aspects of the knee (including the popliteal fossa).
Anatomy: The knee consists of two major joints, the tibiofemoral joint and the patellofemoral joint. In this case, the problem will be localized in the patellofemoral joint: Two ligaments that are most associated with PFPS are the two collateral ligaments (lateral and medial), because they are merged with the knee capsule.
Tendons of knee: The quadriceps tendon joins the thigh to the kneecap (patella) while the patellar tendon joins the kneecap to the tibia (shinbone). Any of these muscles and tendons can be injured.
The Infrapatellar fat pad: Sometimes known as Hoffa’s pad, is a soft tissue that lies beneath the patella(kneecap) separating it from the femoral condyle (end of the thigh bone). In situations where forces are directed at the patella, it acts as a shock absorber, thus protecting the underlying structures.
Synovial tissue: Is a highly specialized tissue that keeps the articular joint well lubricated, whilst at the same time provides nutrients to the articular surface. A joint needs a small amount of synovial fluid to work.
Etiology: Patellofemoral pain syndrome occurs when nerves sense pain in the soft tissues and bone around the kneecap. These soft tissues include the tendons, the fat pad beneath the patella, and the synovial tissue that lines the knee joint. (aaos.org. 2021).
- Can be due to patellar trauma.
Mostly multifactorial causes- It is more likely that PFPS is worsened and resistive to treatment because of several of these factors:
- overuse and overload of the patellofemoral joint
- Anatomical or biomechanical abnormalities,
- Muscular weakness,
- imbalance or dysfunction.
- One of the main causes is the patellar orientation and alignment. When the patella has a different orientation, it may glide more to one side of the femur which can cause overuse/overload (overpressure) on that part of the femur which can result in pain, discomfort, or irritation.
- A muscle and ligament that can cause a patellar deviation is the iliotibial band or the lateral retinaculum in case there is an imbalance or weakness in one of these structures.
- Due to knee hyperextension, lateral tibial torsion, valgus or varus, increased Q-angle, tightness in the iliotibial band, hamstrings, or gastrocnemius.
- Hip kinematics can also influence the knee and provoke PFPS. A study has shown that patients with PFPS displayed weaker hip abductor muscles that were associated with an increase in hip adduction during running.
Signs and symptoms:
Sometimes the pain and discomfort are localized in the knee, but the source of the problem is somewhere else. Anterior knee pain is aggravated by activities that increase patellofemoral compressive forces such as: ascending/descending stairs, sitting with knees bent, kneeling, and squatting.
Differential diagnosis:
Cook et al., (2012) suggest a positive diagnosis of patellofemoral pain syndrome when
- Both pain on muscle contraction and pain on squatting are present
- 2 out of 3 of the following are present – pain on muscle contraction and/or pain on squatting and/or pain on palpation.
- 3 out of 3 are present – pain on muscle contraction, pain on squatting and pain on kneeling.
- Iliotibial band friction syndrome
- Osteoarthritisin the knee
- Chondral lesions
- medial meniscus tears
- Medial overload syndrome
- ACL (anterior cruciate ligament) tear
- PCL injury/rupture
- Referred pain from the hip joint (e.g., slipped epiphysis in adolescents, FAI in young adult, OA)
- Referred pain from lumbar spine.
Treatment
- McConnell Taping for PFPS (Useful for pain relief in entail management)
Technique:
- Stretchy adhesive fabric tape.
- Rigid non stretch tape.
- Skin should be shaved so that tape sticks.
3 strips of base tape:
- Above patella across medially no tension
- Tibial tuberosity and then medially no tension
- Tibial tuberosity and apply laterally.
- Knee should be able to move as no tension.
- Anchor rigid tape while lifting skin.
- Orthotics
- Hip flexor strength.
- Strengthening quadriceps
Special Tests
- Ober (IT band/tensor fascia latae) and Thomas (hip flexor) tests.
Outcome Measure
- Lower extremity functional scale
References
aaos.org. 2021. Patellofemoral Pain Syndrome – OrthoInfo – AAOS. [online]
Available at: <https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/> [Accessed 1 July 2021].
Albornoz-Cabello, M., Barrios-Quinta, C. J., Barrios-Quinta, A. M., Escobio-Prieto, I.,
Cardero-Durán, M. D. L. A., & Espejo-Antunez, L. (2021). Effectiveness of tele-prescription of therapeutic physical exercise in patellofemoral pain syndrome during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 18(3), 1048.
Cook, C., Mabry, L., Reiman, M. P., & Hegedus, E. J. (2012). Best tests/clinical findings for screening and diagnosis of patellofemoral pain syndrome: a systematic review. Physiotherapy, 98(2), 93-100.