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Patellofemoral Pain Syndrome (PFPS) is the most common over-use, running-related injury. Roughly\u00a040% of runners every year will suffer a knee injury and more than half of those injuries are attributable to patellofemoral pain syndrome. Female runners are twice as likely as male runners to suffer from PFPS.\u00a0In spite of its prevalence,\u00a0patellofemoral pain syndrome remains an orthopedic enigma because of a multitude of contributing causes.<\/p>\n

What is patellofemoral pain\u00a0syndrome?<\/strong>
\nThe patella is another\u00a0name for your knee cap. The femur is your thigh bone. As your knee flexes and extends, the patella glides over the end of the femur. This movement occurs at the patellofemoral joint. Patients with PFPS typically complain of diffuse pain around the front of the knee. Overuse, rather than a specific injury, is the cause in most cases.\u00a0The pain is aggravated by bending and flexing of the knee such as in running and jumping, and it improves with rest. Swelling can be present.<\/p>\n

How is patellofemoral pain syndrome diagnosed?<\/strong>
\nClinical examination and patient history are typically sufficient to make the diagnosis of patellofemoral pain syndrome. Additional studies such as x-ray and MRI are sometimes used to assist in the diagnosis and to rule out other potential problems such as: arthritis, bone spurs, meniscal injuries, bursitis, and tendonitis. A\u00a03D gait examination is the best diagnostic tool to identify movement patterns contributing to PFPS.<\/p>\n

What causes patellofemoral pain syndrome?<\/strong>
\nThe cause of patellofemoral pain syndrome has remained vague and controversial primarily because there are several biomechanical and anatomical factors with which it has been associated.\u00a0For instance, as the femur (thigh bone) internally rotates it displaces from under the patella (knee cap). This misalignment causes increased pressure between the two bones leading to pain. Research has shown that it is the femur that moves out of position rather than the patella. In addition, those runners who suffer from “knock-knees,” or what doctors call genu valgum, are more likely to suffer from patellofemoral pain syndrome. Even slight amounts of this inward tilt of the femur can increase the chances of developing PFPS. This explains why women are twice as likely to suffer from PFPS as men. The movement of foot also affects the knee through twisting forces generated by the transfer of weight over the foot during running. To date, there is some evidence that over-pronation can lead to misalignment at the patellofemoral joint and thus pain. However, poor foot biomechanics are unlikely to be the sole cause of patellofemoral pain syndrome.<\/p>\n

How is patellofemoral pain syndrome treated?<\/strong>
\nTreatment for PFPS focuses on two main problems: inflammation and pain along with poor biomechanics. Inflammation can be treated with non-steroidal anti-inflammatory drugs (NSAIDs) and ice. Sometimes cortisone injections are needed to reduce pain and inflammation if severe enough. Biomechanical deficiencies are treated with strengthening and stretching exercises along with physical therapy. Foot orthotics have been show to effectively improve pain in PFPS patients. Knee bracing and taping have been show to help with symptoms in patellofemoral pain syndrome, but on their own they are less effective than other treatments. Rarely, but sometimes, surgery is necessary to treat inflammation and damage within the patellofemoral joint.<\/p>\n

When can I return to running?<\/strong>
\nThe goal of rehabilitation is return you to running as soon as is safely possible. If you return to a full training load too soon, the injury may return or worsen. Everyone recovers from injury at a different rate, so don’t compare your rehabilitation to other runners. Returning to running is determined by how well your knee responds to treatment rather than a set number of days or weeks. In general, the longer you have had the symptoms, the longer it will take you to recover. Here are some general guidelines for a full return to running. Keep in mind, some runners may not have to completely stop running, but merely reduce their training load (distance, intensity, frequency) during the rehabilitation process.<\/p>\n