What Are The Symptoms Of PFPS?
Pain is the main symptom of PFPS. Pain can be felt as an ache at the front of the knee which can increase to a sharper pain with certain activities. Symptoms can range in severity from mild to severe. It can affect one or both knees.
Common symptoms include:
- Pain at the front of the knee, around and behind the kneecap
- Worsening pain during or after increased activity or exercise
- Pain after prolonged sitting
- Pain when squatting or going down stairs
Some people get a clicking or grinding noise when they bend or straighten the knee. This does not mean that you are causing damage and it is important to keep moving your knee joint.
How Common Is PFPS?
PFPS is one of the most common knee complaints and the most common overuse injury affecting the leg. Around a quarter of all adults and a third of adolescents may experience symptoms at some stage. The condition affects both men and women of all age groups but women are twice as likely as men to develop PFPS. It can affect those who participate in sporting activities as well as those who do not.
What Causes PFPS?
PFPS usually occurs without an injury to the knee, but can very occasionally be as a result of an injury, such as a fall onto the knee. If you have not injured your knee, it may be difficult to find one specific cause of your PFPS, as it often occurs for a number of reasons. These include:
- Starting a new activity
- Increase in the intensity and/or frequency of an existing activity
- Following a period of reduced activity that leads to weakening of the muscles
- Muscle tightness or weakness around your hip and knee
- Unsupportive footwear such as high heels or very flat shoes
- Having an job which requires frequent, prolonged kneeling
- Being overweight
Why can overuse cause pain?
Depending on your day to day routine, you will have a level of activity that your knee is happy with. This can be thought of as your knee’s comfort zone or happy place. Any sudden change to your daily activities which leads to putting more weight through your knee can take your knee out of its comfort zone. Examples of this might be working extra shifts and being on your feet more or a sudden change in your sporting activities such as increasing your running distance. This sudden change can cause the knee to become painful without any physical injury to it.
What Can Help With PFPS
PFPS usually responds well to management with specific exercise and lifestyle changes. Only a handful of cases will ever require surgery.
The latest research into PFPS has found:
- Exercise is recommended to reduce pain in the short, medium and long term
- Exercise improves function in the medium and short term
- Combining hip and knee exercises (e.g. squats) is recommended for all patients
- Orthotics are special shoe inserts which help to support your foot and ankle. If there is an issue with the alignment of your foot/ankle such as over pronation (flat feet) then this may also impact on your knee pain. Better alignment of the foot takes stress off your lower leg and knee.
- Patellar taping to improve the movement of the patella (knee cap) may be used by a physiotherapist to help reduce pain while you exercise/ move especially in the early stages.
Pain relief
Change your activity level
To ease the knee pain, it is recommended to pace yourself rather than stopping all forms of movement or exercise. Stopping all activity would result in muscles getting weaker which could lead to the knee pain getting worse. Instead, try to spread your activity out through the day with regular short rests. Break harder jobs down and do gentler activity in between.
When climbing stairs you may need to consider using handrails and go up one leg at a time until your muscles become stronger. It is easier to go upstairs leading with the non-painful leg and then come down with the sore leg leading.
If you only have pain while exercising try to reduce or change your exercise rather than stopping it completely. For example, if running causes you pain, reduce how long you run for or opt for a flatter route. Another option would be to choose an exercise you are more comfortable with (i.e. reduce the load on your knee) such as swimming or cycling and build up your leg strength that way. You may feel it is beneficial to reduce high impact exercise (two feet off the ground) to lower impact exercise (one foot on the ground at any one time). For example you could march instead of jogging in an exercise class.
Exercise
Exercise has been shown to be key in managing patellofemoral pain syndrome. There are three main types of exercise that can be beneficial :
- Strengthening exercises
- Stretching exercises
- Endurance exercise
Strengthening exercises: Building up the strength of your hip and knee muscles can reduce knee pain. Research shows doing combined hip and knee exercises are the most effective. Some examples of strength exercises include free/machine weights in the gym, pilates or yoga. Here are some strength exercises you can do at home.
It is important to note it can take 6 – 8 weeks of doing specific exercises to notice a difference in your knee pain. It can take a further couple of months before you feel better. The exercises below are divided into early, middle and late stages. You should start doing the early exercises first and should find them easy before you progress to the middle exercises. Again you should begin to find the middle exercises easy before you progress to the late exercises.
- VIDEO 1: EARLY STRENGTHENING
- VIDEO 2: EARLY STRENGTHENING
- VIDEO 3: EARLY MOVEMENT
- VIDEO 4: MIDDLE TO LATE STRENGTHENING
- VIDEO 5: MIDDLE TO LATE STRENGTHENING
- VIDEO 6: MIDDLE BALANCE
- VIDEO 7: LATE STRENGTHENING
- VIDEO 8: LATE STRENGTHENING
In the online NHS fitness studio there are many videos you can access for free.
- https://www.nhs.uk/conditions/nhs-fitness-studio/
- https://www.nhs.uk/conditions/nhs-fitness-studio/chair-based-pilates-exercise-video/
- https://www.nhs.uk/conditions/nhs-fitness-studio/knee-problems-pilates-exercise-video/
The aim is to do exercises that are challenging your muscles but are relatively pain free. Do them regularly, usually daily, for 12 weeks. As soon as the exercises become easy to do move onto the more challenging exercises. If the exercises become painful, stop and choose an easier level of exercise.
Stretching exercises: Loosening tight muscles around the knee and hip can help reduce pain. For example hamstring, quadricep and calf muscles.
Endurance exercise: This includes exercises that work your muscles over a long period of time e.g. walking, running, cycling, swimming or aerobics. Choose an exercise that matches your fitness level and your pain level and aim to do it several times a week.
If you are used to exercising regularly but find your usual exercise painful you may need to reduce the amount you are doing or change exercise altogether (cross training) until your pain has improved.
If you are not used to exercising regularly you could try starting with a short walk a few times a week. Try to increase this as your pain allows.
Footwear
Some people benefit from wearing supportive shoes. For example a training style shoes which lace up and provide good support for the arches of your feet.
Weight Management
Being overweight can contribute to this condition so maintaining a healthy weight can help reduce pain.
Helpful Tops
- Wear well-fitting, supportive trainers ideally supporting the arch of your foot
- If you are increasing any sporting activity do it gradually. Sudden increases can overload the patellofemoral joint and increase pain
- It is important to maintain good flexibility and strength in your thigh and calf muscles so a regular exercise programme is recommended
- Maintaining a healthy weight can help to reduce symptoms
- Avoid wearing high heeled shoes
Timescales/Prognosis
It may take up to 12 weeks before you notice a significant improvement in your symptoms but you should notice some gradual improvements along the way. Change will not happen overnight so it is important that you follow the advice regarding lifestyle changes, training modification and exercise. Doing this will help you successfully manage your condition and increase your chances of a successful outcome.
Help And Support
If after following the above advice, your symptoms have not improved within 6 to 12 weeks, a referral to a physiotherapist may be beneficial.
You can access physiotherapy by any of the following:
- Completing this online self-referral form
- Speak to your GP about a referral
