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Patellofemoral pain syndrome (PFPS)

What is patellofemoral pain syndrome?

The collective term “patellofemoral pain syndrome” refers to pain in the front of the knee and the kneecap (patella). The pain usually occurs behind the kneecap but can also radiate into the areas in front of and around the kneecap. 

Patellofemoral pain syndrome is very common and one of the most frequent problems in the front of the knee. Generally, pain first occurs during strain such as using the stairs, hill walks or skiing. 

Patellofemoral pain syndrome frequently affects young, active women, but also people who enjoy sports that put a lot of strain on the knee from jumping, shock absorbing or decelerating. 

Additionally, misalignments such as knock knees,  anomalies such as a high-riding patella, muscular imbalances and muscles that are too weak to stabilise the kneecap can be a trigger for patellofemoral pain syndrome.

The painful area in the case of patellofemoral pain syndrome

Location of the pain

In the case of patellofemoral pain syndrome (PFPS), the pain occurs in the patellar guidance channel between the thigh bone and the kneecap.  If the kneecap isn’t positioned exactly in this guidance channel, knee pain will occur, in particular during strain.

 

Patellofemoral pain syndrome has many names

Many people know patellofemoral pain syndrome under its previous descriptions “chondropathy” or “chondropathia patellae.” In Germany, the condition is also known as front knee pain,  retropatellar pain syndrome, retropatellar joint pain or retropatellar pain,  but parapatellar pain syndrome, chondromalacia patellae, chondromalacia patellae and chondromalacia are also used. The abbreviation PFPS is also used for patellofemoral pain syndrome and FPS for femoropatellar pain syndrome.


Causes of patellofemoral pain syndrome

The exact cause of patellofemoral pain syndrome often remains unidentified. However, there are various situations that can trigger the condition:

  • Muscular imbalances

The patella usually sits in the guidance channel of the thigh bone. This acts as a guide rail. The patella is also stabilised by the muscles and lateral ligaments. If the path of the patella is changed due to muscular imbalances, friction can occur that may cause severe pain.

 

  • Misalignment of  the patella

The surrounding ligaments and muscles pull the patella more to one side, which results in deformation or misalignment of the patella. The patient suffers from iliotibial band syndrome (runner’s knee) caused by excessive strain on the tractus iliotibialis. This is a fascial strip that supports the muscles on the outside of the thigh.

 

  • Malformation (dysplasia) of the patella  

If the kneecap has an asymmetric shape, the term is “patella dysplasia.” This malformation is usually congenital and, based on excessive one-sided strain, can cause increased cartilage wear underneath the kneecap. 

 

  • Knock knees

In cases of leg misalignment, the knee isn’t loaded correctly, resulting in inappropriate stress. This can  lead to cartilage wear and joint damage and consequently retropatellar joint pain, i.e. pain behind the kneecap.


Comprehensive treatment of patellofemoral pain syndrome

Conservative therapy, particularly when comprehensive treatment includes various elements, can be very successful in the case of patellofemoral pain syndrome.  A combination of medical products, controlled movement, physical therapy and self-management is the key to success.

Treatment with medical products

In the case of chronic or acute knee joint pain, knee orthoses or supports can be used. A reduction in pain can be achieved thanks to additional stabilisation and compression of the knee joint. To complement the medical product used on the knee, it is often necessary to have orthopaedic insoles made.

In order to counteract recurring pain, a knee orthosis or support can also be worn preventatively against excessive strain.

Treatment with JuzoPro Patella Xtec Plus

Orthosis used to influence the path of the patella

The JuzoPro Patella Xtec Plus is used to treat patellofemoral pain syndrome. The orthosis features a horseshoe-shaped pad around the kneecap. It is centred by a closure mechanism that guides the path of the kneecap.  Thanks to its nubs, this pad also stimulates the muscles on the inside of the thigh (musculus vastus medialis). A second pad relieves the patellar tendon and alleviates pain thanks to its nubs.

 

Treatment in 2 stages according to requirements  
The JuzoPro Patella Xtec Plus orthosis can be adapted to the requirements of individual treatment stages.  During the acute phase, the medical compression class 2 compression knit helps to counteract swelling. For the second stage of treatment, in consultation with a doctor, the centring pad can be combined with the included patella strap.


Movement

During the acute phase, whatever is causing the strain should be stopped immediately. As soon as it’s not too painful, targeted mobilisation can start. The type and extent of the exercises should be discussed with the doctor supervising treatment. Resting for too long can have a counter-productive effect because the supporting muscles can atrophy, causing increasing imbalances.  Regular exercises strengthen the muscles, thus compensating for imbalances. 

Exercises for strengthening and prevention 

The JuzoPro Patella Xtec Plus orthosis helps to guide the kneecap back into its correct position, thus supporting pain-free mobility.  Tailor-made exercises help to strengthen the supporting muscles and compensate for imbalances. Juzo has collated the following selection of exercises in cooperation with therapists.

  • Exercise 1: Step-up
  • Stand with your feet hip-width apart on an exercise step or a similar stable object (ca. 20 cm)
  • Using a controlled movement, tap one foot on the ground, pull this leg back an repeat
  • Ensure that the your knee  doesn’t go further than your toes!

 

3 x approx. 15 to 20 repetitions on each side


  • Exercise 2: Seated diagonal movement
  • Sit on a chair, with your legs bent at a 90° angle
  • Raise one leg towards your chest, with your toes rotated inwards
  • Extend your leg and rotate your toes as far outwards as possible

 

3 x approx. 15 to 20 repetitions on each side


  • Exercise 3: Step Up Plus
  • Stand with your feet hip-width apart in front of an stable objct (approx. 20 cm height)
  • Climb onto the step with a controlled movement
  • Pull the other knee up in a controlled manner
  • Caution: the knee must not project beyond your toes!

 

3 x approx. 15 to 20 repetitions on each side

  • Exercise 1: Squats
  • Stand with your legs about shoulder-width apart, feet slightly turned outwards
  • Bend your knees slowly (your buttocks move backwards) and return to the starting position
  • Enure that your knees doesn't go in front of your toes
  • Important: your knees and toes must always point in the same direction!

 

3 x 10 to 15 repetitions


  • Exercise 2: Split-Squats
  • Place a balance cushion or thick towel on the ground in front of you
  • Take a big step forwards in a straight line
  • Bend the back knee
  • Ensure that the front knee doesn’t go further than your toes!

 

3 x 10 to 15 repetitions on each side

  • Exercise 1: Wall-sit dynamic
  • Stand with your back against a wall (ideally with a soft ball)
  • Slowly squat down and return
  • Ensure that your toes point slightly outwards!
  • To make the exercise more intense, bend your knees at a 90 degree angle
  • To make the exercise even more intense, stretch out your arms in front of you 

 

3 x 10 to 15 repetitions


  • Exercise 2: Wall-sit
  • Stand with your back against a wall
  • Slowly squat down
  • To make this exercise more intense, lift your toes and hold them in position
  • To make this exercise even more intense, alternately lift one leg

 

3 x 10 to 15 repetitions on each side


  • Exercise 2: Wall-sit single leg
  • Stand with your back against a wall
  • Alternately stretch your legs while rotating the toes outwards

 

3 x 10 to 15 repetitions on each side


Physical therapy

In addition to regular exercise, comprehensive treatment also includes physical therapy. With this process, it’s important to adjust the methods to suit the indication  and the individual’s pain level.

Physical therapy includes, for example, treatment such as physiotherapy, manual therapy, massage, thermotherapy, electrotherapy, ultrasound and hydrotherapy. Several treatment options can be combined.


Alternative treatment options

Shock wave therapy, injection therapy, Kinesio taping and acupuncture are other treatment options.