Therapies, Physiotherapy -  LUHFT wide

What is patellofemoral pain?

  • Patellofemoral pain refers to discomfort on the front of the knee, around and behind the knee cap. It is a common condition that can affect anybody of all ages, whether you are very active or less active.

Symptoms of patellofemoral pain:

  • You may develop pain at the front of your knee, around your kneecap. Pain can also move up the thigh, behind the knee or down the shin.
  • Activities that can be painful with patellofemoral pain include kneeling, squatting, running, using stairs or sitting for a long time.
  • You may notice some grinding or grating sounds from your knee – this is called crepitus and is quite normal for this condition. It does not mean that harm is being done when moving the knee.

What causes patellofemoral pain?

  • The factors that cause patellofemoral pain are complex, and the exact cause is not completely clear. It is thought that changes in how kneecap moves in the knee groove can result in pressure and pain. It has also been suggested pain can also arise from changes in the tissues around the kneecap joint such as the joint lining, making the area more sensitive.
  • Some factors that are thought to possibly increase the sensitivity around the kneecap are:
  • Sudden increases to physical activity which your knee struggles to cope with.
  • Weakness of the hip muscles.
  • Weakness of thigh muscles.
  • Too much foot roll (pronation).
  • Injury (for example a heavy fall onto the knee).

Treatment options:

  • Changing your activity levels slowly reducing the activities that are painful (squatting, kneeling etc.) until you can complete the activity without discomfort.
  • Exercise Therapy: exercise therapy is the most important treatment in the management of patellofemoral pain. You should complete exercises that aim to increase the strength of both your knee and hip.
  • Taping: Taping can reduce pain during activities like running, walking on stairs, and squatting.
  • Orthotics: Foot orthotics sometimes reduce pain - your therapist will help you decide if they are appropriate or refer you to someone who can.

What doesn’t help:

  • Avoiding exercise.
  • Passive treatments (dry needling, isolated manual therapy, neuromuscular electrical stimulation, ultrasound, therapeutic laser).

Top tips:

  • Your recovery will be best if you actively participate in your rehabilitation.
  • Changing your physical activity level is often the first step towards successful recovery.
  • Starting exercises in sitting or lying to get your thigh and hip muscles working without pain – see some suggestions below.
  • Ensure you slowly and safely build up your physical activity levels.
  • As soon as pain allows, exercises should be performed in standing.
  • Recovery can take time, often 12 weeks or more.
  • Should your pain not improve after following the advice in this leaflet and trying the below exercises within three months, you may benefit from an assessment and treatment advice by a Physiotherapist. Your GP practice can organise this for you.

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Strengthening exercises:

Single leg bridge:

 

Lie on your back with your knees bent and feet flat on the floor.

Rest your arms on the floor by your sides.

Keeping your knee bent, lift one foot off the floor.

Press your other foot against the floor and lift your hips up.

Try to straighten your hips so that you have a straight line from your shoulders to your knee. In a controlled manner lower your hips back down, and repeat.

Keep your pelvis level throughout this exercise.

 

Side Lying Hip Abduction against a wall:

Start by lying on your side with your back against a wall. You can place a small towel between the wall and the heel of your upper leg, if needed. Slightly press your upper hand against the floor in front of you.

Lift your leg upwards and at the same time press it against the wall. Keep your leg straight and the heel in firm contact with the wall. Return to the starting position.

Wall sit:

Stand up straight with a wall positioned behind you.

Lean your back and buttocks against the wall, then walk your feet forward.

Slide down the wall until you reach a 90-degree angle at your hips and knees.

Ensure your back and buttocks remain in contact with the wall.

Hold this position.

Straight leg raise – long sitting:

Start in a seated position on a bench with your legs stretched out in front of you.

Bend your toes in towards you and push your knee down into the bench.

Raise one leg slightly.

Hold, and then return to the starting position.

Repeat.

 

Further information

 

Royal Liverpool and Broadgreen Hospital

Tel: 0151 706 2760

Textphone Number: 18001 0151 706 2760

 

Aintree Hospital

Tel: 0151 529 3335

Textphone number: 18001 0151 529 3335

 

Author: Physiotherapy - Therapies Care Group

Review date: July 2029

PI 3257 V1