Treating Chronic Patella Femoral Pain (PFP)
By Bri Keary AEP Grad Cert. Mental Health (Candidate)
Patella Femoral Pain or PFP is among the most common explanations for knee pain and doesn’t discriminate between age groups or activity levels (read more).
The condition represents a general laxity of the patella over the knee joint, putting biomechanical stress surrounding structures and eventually causing symptoms. It can be experienced as a gradual and non-traumatic onset of knee pain. The discomfort may be hard to pinpoint in location and differs between people.
Activities such as running, squatting and using stairs tend to be aggravating movements. There lacks a consensus for the exact pathophysiology of PFP (read more) and as a result, the term is often used for a range of instances where pain is experienced around the patella. Although evidence supports certain approaches, each case should therefore be treated on an individual basis.
Causes of PFP
PFP can be understood as a type of ‘overuse injury’ caused by using the body in a way that it is not currently equipped to deal with.
When the knee bends, the patella ideally travels smoothly down a groove in the front of the knee joint. The quadriceps muscles and patella tendon connect to the patella and apply force from different directions. When there is a lack of synchrony or imbalance in how these muscles work together, it can affect the line of pull of the patella as the knee bends. This can disrupt how the patella glides over the joint and potentially lead to uncomfortable symptoms in surrounding structures.
For long-term recovery, a more holistic approach is necessary. Like most chronic pain, central nervous system mechanisms will contribute to some extent including:
- High mental stress
- Altered pain experiences
- Past healthcare experiences
- Trauma or early childhood adversities
- Emotional dysregulation
Click the links below to read more of the research behind it:
Quantitative sensory testing of patients with long lasting Patellofemoral pain syndrome
Patellofemoral pain syndrome: pain, coping strategies and degree of well-being
Allied Health Professionals can support recovery by identifying contributing factors and treating them in a way that is compassionate to the unique biopsychosocial dynamics of the client.
Evidence-based approaches include –
- Addressing tightness of the knee and hip muscles. Although not always a cause of PFP, this will assist with the recovery process and may be a useful tool to regulate symptoms temporarily.
- Strength training. Relative quadriceps weakness is a potential risk factor for PFP (read more). Additionally, training the quadriceps, glutes and hamstrings appropriately helps improve muscle fibre reactivity, muscular endurance and lower limb movement patterns in those with PFP (read more).
- Encourage strength in external hip rotation. Excessive internal rotation of the femur can compromise patella tracking over time and exacerbate symptoms (read more).
- Ensuring foot/ankle biomechanics are adequate. Excessive foot pronation and subsequent ankle joint changes are consistent in some people with PFP. This may be a cause or effect of the condition. Either way, rectifying these issues will be helpful to the recovery process (read more).
- Honouring past experiences and current perceptions of pain. Research shows that one’s narratives and beliefs around chronic pain can have a strong impact on symptom experiences and recovery outcomes. This should always be taken into consideration and can be positively affected by evidence-based trauma-informed treatment (read more).
Like any chronic condition, it is futile to focus on a ‘fix’, but rather find movement strategies and tools to empower the client to build confidence in their body and health management.
There’s no need to get tied up in the label of PFP. It’s a commonly used term for discomfort around the knee where strength and/or movement quality doesn’t align with the activity demands on the body. Luckily, as the condition is so common, there is reasonable evidence around successfully treating the condition. With some informed guidance and consistency, recovery is likely!
