Patellofemoral pain syndrome: symptoms and treatment

The patellofemoral pain syndrome, also called the ‘kneecap pain syndrome’, refers to complaints that are observed in and around the kneecap. Patella is another word for kneecap. Patellofemoral pain syndrome occurs at all ages, but is most commonly seen during puberty. It occurs more often in women than in men. The condition usually goes away on its own after one to several months. Exercises that strengthen the large thigh muscle located in the front of the thigh can help. Taping or a brace has shown little or no effect on patellofemoral pain syndrome.

Patellofemoral pain syndrome

  • What is patellofemoral pain syndrome?
  • What causes patellofemoral pain syndrome?
  • What are the symptoms and complaints?
  • How is the diagnosis made?
  • How is patellofemoral pain syndrome treated?
  • Wait and see policy
  • Pain relief
  • Exercise for patellofemoral pain syndrome: strengthening the large thigh muscle
  • Ice pack and put less strain on the knee
  • Taping and bracing for patellofemoral pain syndrome

Pain in the knee due to patellofemoral pain syndrome / Source: Africa Studio/Shutterstock.com

What is patellofemoral pain syndrome?

Patellofemoral pain syndrome is a condition that mainly affects teenagers and young adults. With this syndrome you have pain in your knee or sometimes in both knees. The condition occurs slightly more often in women than in men. Patella is the Latin word for ‘kneecap’ and femoral means of the upper leg. With this syndrome, the kneecap does not track properly in the grooves of the thigh. This causes pain, which increases when the pressure on the knee increases (for example when you squat, kneel, climb stairs or when cycling against a headwind) and decreases with rest and when stretching the knee.

What causes patellofemoral pain syndrome?

The kneecap is located on the knee joint and the kneecap slides over the knee joint when stretching and bending the leg. Sometimes this causes irritation and pain. Both endogenous and exogenous factors are mentioned as causes, such as overload, incorrect loading, trauma (bruising of the area around the kneecap) or reduced muscle strength. The syndrome mainly occurs in adolescents and young adults, more often in girls than in boys.

What are the symptoms and complaints?

Patellofemoral pain syndrome has a variety of presentations. Patients present with knee pain behind, under or around the kneecap or with other symptoms such as:

  • a cracking, crackling or snapping sound when moving (crepitations);
  • stiffness and swelling;
  • a feeling of instability, especially when climbing stairs, which cannot be attributed to other conditions;
  • the complaints sometimes occur on both sides, but usually the complaints are one-sided.

GP examines knee / Source: Denis Simonov/Shutterstock.com

The pain is mainly felt during and after strain (sports, cycling or climbing stairs) and when sitting with bent knees (‘theatre sitting phenomenon’). The condition is painful and can cause anxiety. For example, you may be afraid that you will become disabled at a young age. However, this syndrome is not a harbinger of premature wear or osteoarthritis and, as a rule, the complaints disappear spontaneously after a few months to years. (In osteoarthritis, the cartilage changes, causing symptoms such as stiffness and joint pain.)

How is the diagnosis made?

The diagnosis can often be made on the basis of anamnesis and (extensive) physical examination, for example by your GP. Sometimes additional imaging tests are necessary to rule out underlying causes. At a younger age, apophysitides (bone-tendon attachments) are eligible as a differential diagnosis, such as Osgood Schlatter’s disease and Sinding Larsen Johansson syndrome.

How is patellofemoral pain syndrome treated?

Wait and see policy

It is often advisable to adopt a wait-and-see policy, as the patellofemoral pain syndrome is self-limiting and disappears within a few months to years.

Paracetamol has an analgesic effect / Source: Martin Sulman

Pain relief

Paracetamol can help with persistent pain, possibly ibuprofen (if you are 16 years or older). If the complaints persist for longer than 4 to 6 weeks, it is wise to consult your doctor.

Exercise for patellofemoral pain syndrome: strengthening the large thigh muscle

Treatment can consist of strengthening the large thigh muscle located at the front of the thigh, as this has a beneficial effect on the tracking of the kneecap. It is important that you train this group of muscles properly. That is why this specifically targeted strength training should preferably be supervised by a physiotherapist.

Ice pack and put less strain on the knee

You can combat pain or swelling in the knee after exercise or a bike ride, for example, by holding an ice pack against it. If you frequently suffer from severe pain, it may be wise to cut back on the sport or exercise that triggers the pain for a few months. You can practice sports or activities that cause less pain, such as swimming or cycling. Keeping moving is good, but don’t force yourself and take the limits that your body sets seriously. If you notice that the pain becomes clearly worse during or after strain, you should put less strain on the knee.

Taping and bracing for patellofemoral pain syndrome

Although McConnell taping, which uses a taping technique combined with specific exercises for knee mobility and stability, has become a popular treatment component for this syndrome, its effectiveness has not yet been demonstrated. Little or no effect has also been demonstrated of a brace.

read more

  • Knee pain: stabbing, burning or aching knee pain
  • Knee pit cyst or Baker’s cyst: symptoms and treatment
  • Tendonitis: tendinitis in the shoulder, wrist, knee or thigh
  • Osgood-Schlatter disease: symptoms, cause, treatment
  • Hip pain: causes of hip pain or painful hips

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