If you’re having knee pain, we want you to know you’re not alone. We actually hear this all the time. In fact, knee pain is one of THE most common problems that we see in our clinic. It’s easy to think that knee pain is something that just comes with age, or will go away on its own. But if you’re living with painful knees, they’re painful and they ache, it’s hard to imagine what life would be like without pain.
What is Patellofemoral Pain?
Patellofemoral pain is the term used to describe pain around the front of the knee and knee cap, or patella. Sometimes, it’s also referred to as “runner’s knee” as it’s common among runners and athletes. Pain occurs in the knee cap when the soft tissue and bone surrounding the knee cap are overused and become inflamed.
What Are the Symptoms of Patellofemoral Pain?
- Pain in the knee while exercising or bending the knee
- Pain after sitting for long periods of time when your knees are bent, such as on a plane
- Popping or crackling noises when you move your knees after long periods of sitting or inactivity
How is Patellofemoral Pain Diagnosed?
According to the new practice guidelines, there are three ways to diagnose patellofemoral pain.
- Through the reproduction of pain during squatting, sitting, or other functional activities
- Based on the presence of pain, the ability to reproduce the pain through sitting, climbing stairs, or other functions, and the exclusion of all other conditions that may cause knee pain
- Using a patellar tilt test with the presence of hypermobility
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Click here to read the entire clinical practice guidelines.
According to the Journal of Orthopedic & Sports Physical Therapy, These are the Four Subcategories of PFP Impairment/Function-Based Classification
1. Overuse/overload without other impairment: a subcategory of individuals with PFP may have pain primarily due to overuse/ overload. Classification into the overuse/overload without other impairment subcategory is made with a fair level of certainty when the patient presents with a history suggesting an increase in magnitude and/or frequency of PFJ loading at a rate that surpasses the ability of his or her PFJ tissues to recover.
2. Muscle performance deficits: a subcategory of individuals with PFP may respond favorably to hip and knee resistance exercises. Classification into the muscle performance deficits subcategory is made with a fair level of certainty when the patient presents with lower extremity muscle performance deficits in the hip and quadriceps.
3. Movement coordination deficits: a subcategory of individuals with PFP may respond favorably to gait retraining and movement re-education interventions leading to improvements in lower extremity kinematics and pain, suggesting the importance of assessing dynamic knee valgus during movement. The diagnosis of PFP with movement coordination deficits is made with a fair level of certainty when the patient presents with excessive or poorly controlled knee valgus during a dynamic task, but not necessarily due to weakness of the lower extremity musculature.
4. Mobility impairments: a subcategory of individuals with PFP may have impairments related to either hypermobile or hypomobile structures. The diagnosis of PFP with mobility deficits is made with a fair level of certainty when the patient presents with higher than normal foot mobility and/ or flexibility deficits of 1 or more of the following structures: hamstrings, quadriceps, gastrocnemius, soleus, lateral retinaculum, or iliotibial band.
Based on examinations, clinicians should do the following according to the practice guidelines:
Use the Anterior Knee Pain Scale to measure pain levels and functionality.
Administer the appropriate tests to reproduce the pain and assess mobility and coordination, such as squatting, sitting, and stair climbing. This will help establish a baseline status for pain and function
Assess body structure and function including patellar provocation, mobility, foot position, hip and thigh muscle strength, and muscle length.
Clinical Practice Guidelines for Intervention:
- Exercise Therapy
- Patellar Taping
- Patellofemoral Knee Orthoses (Bracing)
- Foot Orthoses
- Running Gait Retraining
- Blood Flow Restriction Training and High-Repetition Knee-Targeted Exercise Therapy
- Needling Therapies
- Manual Therapy
- Biophysical Agents
- Patient Education
- Combination of Interventions