Patellofemoral pain syndrome or PFPS is pain in front of the knee and around the kneecap or patella. The condition is also called runner's knee because it often affects athletes. PFPS can also affect people who are not athletes and the pain tends to make daily activities challenging.

Patellofemoral Pain Syndrome Symptoms

Dull, aching pain in the front of the knee is the most common symptom of patellofemoral pain syndrome. The pain may be in one or both knees. Pain is often aggravated by activities that require bending the knees, such as squatting, going up or down stairs, running, and jumping. Pain may also occur after prolonged sitting with the knees bent, such as after an office workday. Cracking or popping of the knee may occur after sitting for a prolonged period of time or when climbing stairs.

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Patellofemoral Pain Syndrome Causes

The exact cause of patellofemoral pain syndrome is unknown, but factors that lead to it are well-recorded. Sports that require a lot of running and jumping put negative stress on the knees, which can result in irritation behind the kneecap. Injuries to the kneecap, such as a fracture or dislocation, are also associated with patellofemoral pain syndrome. Poor alignment of the kneecap due to issues with the muscles of the knee and hip may also cause the condition, and patellofemoral pain syndrome can develop from the inward movement of the knee during squatting, as well. Knee surgery, especially repair to the anterior cruciate ligament, raises the risk of developing patellofemoral syndrome.

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Risk Factors

Adolescents and young adults are the populations who most commonly develop patellofemoral pain syndrome; knee problems in older individuals are usually a result of arthritis. Women are twice as likely to develop PFPS as men. Experts speculate this could be because women h have wider pelvises than men, which increases the angle at which the bones in the knee joint meet. Not surprisingly, women who participate in sports such as track and cross-country running, which put a lot of stress on the knees, are at increased risk for developing PFPS.

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Diagnosing PFPS

A doctor will assess a patient's knee pain by taking a medical history and performing a physical examination. During the exam, the physician may press on the patient's knee and move the patient's leg around to determine exactly where he or she is experiencing pain. A physician may use imaging tests such as x-rays, computerized tomography (CT) scans, or magnetic resonance imaging (MRI) scans to rule out other possible causes.

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PFPS Treatment: Physical Therapy

A physical therapist may teach a patient with patellofemoral pain syndrome exercises to improve endurance and range of motion and to strengthen the muscles supporting the knee -- the hamstrings and quadriceps. Specific exercises can also help control the alignment of the limbs. Learning to control the inward movement of the knee while squatting is another common goal of this treatment.

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Surgery for PFPS

If other treatments are not effective, a doctor might recommend a surgical option to someone with patellofemoral syndrome.

  • Arthroscopy: During arthroscopy, the surgeon makes a small incision in the knee to remove fragments of damaged cartilage.
  • Realignment: In more severe cases, a surgeon might need to relieve pressure on the cartilage or realign the kneecap.

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PFPS Home Remedies

Simply resting the knee may relieve pain, as overuse is often the cause of patellofemoral pain syndrome. Wearing a knee brace or arch supports can also help. Icing a painful knee after exercising can reduce or prevent later issues, and over-the-counter anti-inflammatory drugs can also alleviate pain. Doctors recommend those with patellofemoral pain syndrome avoid problematic sports while they recover. Swimming and bicycling are good alternative forms of full-body exercise.

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PFPS Prevention: Maintaining Strength

Exercises to strengthen the quadriceps can help keep the kneecap aligned during physical activity. A doctor or physical therapist can show patients exercises to optimize techniques for jumping, running, and pivoting. Exercises to strengthen the outer hip are essential to prevent the knee from turning inward when stepping down, squatting, and landing from a jump.

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Preventing PFPS While Exercising

Stretching before and after exercise and warming up for at least five minutes before beginning more rigorous activity can help prevent patellofemoral pain syndrome. Individuals should increase the intensity of their workout schedule slowly over time. High-quality, supportive footwear can also help prevent injury. Individuals with flat feet may want to consider orthotics.

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Patellofemoral Pain Syndrome Prognosis

In general, individuals with patellofemoral pain syndrome can make changes in their exercise or sports routines and use home remedies to decrease their pain. PFPS may be more challenging to treat in older adults and those who experience pain in both knees. People who develop patellofemoral syndrome following an injury such as a kneecap dislocation may have a longer recovery period.

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