Patellofemoral Pain Syndrome

Overview

What is patellofemoral pain?

Patellofemoral pain is a common knee problem. If you have this condition, you feel pain under and around your kneecap. The pain can get worse when you’re active or when you sit for a long time. You can have the pain in one or both knees.

Causes & Risk Factors

What causes patellofemoral pain syndrome?

The exact cause of patellofemoral pain isn’t known. It probably has to do with the way your kneecap (patella) moves on the groove of your thigh bone (femur).

Treatment

How is it treated?

Usually, putting ice on your knee, changing your activities, and following a physical therapy program works best. This type of program may include exercises to make your muscles stronger and more flexible. Taping the knee or using shoe insoles can be helpful for some people. It may take weeks or months of treatment for the pain to go away.

Exercises to help your knee pain

The exercises in this handout can help strengthen your muscles and relieve your pain. Each exercise should take a few minutes. Doing them twice a day is a good start. Your doctor will tell you which exercises are right for you. After you do the exercises, reverse your position, and do the exercises with your other leg, so both knees get the benefit of stretching.

Be patient! Keep exercising to get better. Patellofemoral pain can be hard to treat, and your knees won’t get better overnight. Some people are lucky and get better quickly. But it might take 6 weeks or longer for your knee to get better. You’ll be less likely to get patellofemoral pain again if you stay in good shape, but don’t make sudden changes in your workouts.

Quadriceps strengthening: Isometrics

Lie flat on a firm surface, such as a floor. Bend your left leg to a 90 degree angle, with your foot flat on the floor. Hold your right leg straight for 10 to 20 seconds and then relax. Do the exercise 5 to 10 times.

Quadriceps strengthening: Straight leg lift

Lie flat on a firm surface, such as a floor. Bend your left leg to a 90 degree angle, with your foot flat on the floor. Raise your right leg several inches, and hold it up for 5 to 10 seconds. Then lower your leg to the floor slowly over a few seconds. Do the exercise 5 to 10 times and then switch legs.

Iliotibial band and buttock stretch

Sit on the floor with your legs out straight. Cross your right foot over your left knee. Twist your trunk to the right and use your left arm to "push" your right leg. You should feel the stretch in your right buttock and the outer part of your right thigh. Hold the stretch for 10 to 20 seconds. Do the exercise 5 to 10 times then switch legs.

Iliotibial band stretch

Stand up straight, with your right leg crossed in front of your left leg. Hold your hands together and move them toward the floor. You should feel a stretch in the outer part of your left thigh. Hold the stretch for 10 to 20 seconds. Do the exercise 5 to 10 times and then switch legs.

Hamstring stretch

Lie flat on the floor with your legs out straight. Bend your left knee toward your chest. Grip your thigh with your hands to keep the thigh steady. Straighten your left leg in the air until you feel a stretch. Hold the stretch for 5 to 10 seconds. Do the exercise 5 to 10 times then switch legs.

Hip adductor strengthening

While sitting, squeeze a rubber ball between your knees. Hold the squeeze for 5 to 10 seconds. Do the exercise 5 to 10 times. (If you don’t have a ball, put your hands or fists between your knees and then squeeze.)

Hip abductor strengthening

For this exercise, use a wall or sturdy chair for balance. Stand on your left leg with the knee slightly bent. You can use you’re left hand to hold onto the wall or chair. Slowly raise your right foot about 30 degrees, hold for a few seconds, and then slowly lower the foot and straighten both legs. Do the exercise 10 times. Don’t let your pelvis tilt (be crooked), and don’t let your knees turn inward during bending. Remember to switch legs.

Calf stretch

Stand facing a wall. Put both hands against the wall and move your right foot back until you can feel a stretch in your calf muscle. Keep your left leg bent, with your knee lined up over your toes. Keep your right heel on the ground to feel the back of the leg stretch. Hold for 10 to 20 seconds. Do the exercise 6 to 10 times and then switch legs.

Bibliography

Questions to Ask Your Doctor

  • What is the likely cause of my knee pain?

  • What is the best treatment option for me?

  • Do I need to do any special exercises to help strengthen my knee and relieve my pain?

  • How long before I can expect relief from my symptoms?

  • Is it possible that my symptoms could return?

  • Is it safe for me to exercise? What kind of exercise should I do?

Tips to help relieve your pain

  • Take a break from physical activity that causes a lot of pounding on your legs, such as running, volleyball or basketball. If you want to keep exercising, try swimming or another low-impact activity. You may want to try working out on nonimpact elliptical trainers, which are popular at gyms. Because these machines support your body weight, they put less stress on your knees. As your knees feel better, you can go back to your normal sports. But do this slowly, increasing the amount of time you do the sports activity a little at a time.

  • Talk to your doctor about footwear. It may help to bring your shoes in for the doctor to see. Proper walking or running shoes can help knee pain. Even a simple arch support insert from a shoe store can be helpful. This insert is less expensive than a custom-made support or brace.

  • Ice your knees for 10 to 20 minutes after activity. This can ease the pain and speed up healing. To keep your hands free, use an elastic wrap to hold the ice pack in place. A medicine such as ibuprofen (one brand name: Motrin) may also help relieve your pain, but talk to your doctor before you take this medicine.

Citations

  • Management of Patellofemoral Pain Syndrome by S Dixit, M.D., JP Difiori, M.D., M Burton, M.D., and B Mines, M.D.(American Family Physician 01/15/07, http://www.aafp.org/afp/2007/0115/p194.html)

  • Patellofemoral Pain Syndrome: A Review and Guidelines for Treatment by MS Juhn, D.O.(American Family Physician 11/01/99, http://www.aafp.org/afp/991101ap/2012.html)