Patellofemoral pain syndrome or pain under the knee cap is the most common diagnosis in the knee and a frequent reason patients seek out the care of their primary care physician or Physical Therapist. Patient’s with this condition often experience aching or sharp pain under or around the knee cap (patella) during squatting, running, jumping, stair climbing, hiking, and prolonged sitting. Pain results from abnormal contact between the knee cap and thigh (femur). Prior thoughts on this condition believed the knee cap was responsible for the abnormal contact and interventions were designed to target the patella.
Outdated theories including balance between the outer and inner quadriceps muscle have been replaced by better research indicating the hip may play a more significant role in the condition. The hip musculature including the gluts contribute significantly to the alignment of the thigh under the knee cap. As the alignment improves a greater portion of the joint surface area is able to distribute the forces across the knee reducing joint pressure and pain. The quadriceps function to dissipate the forces across the knee and should be targeted along with the hip musculature in this condition.
The Journal of Orthopedic Sports Physical Therapy recently published their clinical practice guidelines including the best available medical evidence and expert opinion on how to effectively diagnosis and treat this condition (Willy et al. 2019). Authors reviewed 4500 scientific articles on this condition between 1960 and present day. They selected 271 articles for the review and broke down their findings into the most supported risk factors, examination tests, diagnosis, treatments, and prognostic factors. Authors found most individuals with this condition improve with Physical Therapy interventions including activity modification and strength training. Patients may also benefit from short term (< 6 weeks) utilization of foot orthotics and taping for pain relief. Authors reported manual therapy and dry needling were not shown to be useful for this condition.