Patellofemoral Pain Syndrome (PFPS), often called runner’s knee, is a common condition that affects many people, particularly those involved in activities that require repetitive bending and straightening of the knee.
In this article, we’ll break down the anatomy and biomechanics of the patellofemoral joint, explain the symptoms, and walk you through the diagnosis process. Most importantly, we’ll focus on effective treatments, highlighting manual therapy and exercise-based rehabilitation that can lead to lasting relief.
Our Success Rate is Over 90%
Our approach to treating Patellofemoral Pain Syndrome consistently delivers a 90% plus success rate in reducing pain and restoring function.
Article Index:
Clinical Manifestations
People with Patellofemoral Pain Syndrome (PFPS) often experience symptoms that signal increased stress on the knee joint. Here’s what to look for:
Anterior Knee Pain: A dull, throbbing ache around or behind the kneecap is one of the most common signs.
Activity-Related Discomfort: Pain tends to worsen with activities like squatting, climbing stairs, kneeling, or even sitting for long periods (often called “theater sign” or “moviegoer’s knee”).
Crepitus: You may notice a grinding or grating sensation when moving the knee, usually caused by abnormal patellar tracking or early wear and tear.
Knee Instability: Some patients report feeling as though their knee might "give way," often due to muscle weakness, poor balance, or pain-related compensation.
Post-Activity Soreness: Stiffness or soreness after physical activity or prolonged rest is another common symptom.
Since everyone’s experience with PFPS can vary, it’s essential to take a personalized approach to diagnosis and treatment. Understanding your symptoms is the first step to finding relief and getting back to the activities you enjoy.
Anatomy and Biomechanics
Patellofemoral Pain Syndrome (PFPS) occurs when too much stress is placed on the joint between the kneecap (patella) and the thigh bone (femur). The patella acts as a lever, helping the quadriceps muscles extend the knee. For pain-free movement, the patella must glide smoothly within the groove of the femur.
However, PFPS often develops when this movement is disrupted due to muscle imbalances, poor movement patterns, or structural variations in the knee. For example, weaknesses or tightness in the quadriceps, hip muscles, or hip external rotators can lead to inefficient patellar tracking, putting extra strain on the joint.
Key Players in PFPS:
Patella (Kneecap): This small bone moves along a groove in the femur, but misalignment can cause pain and dysfunction.
Femur (Thighbone): The lower end of the femur contains the groove where the patella tracks, and smooth tracking is vital to avoid strain.
Quadriceps Muscles and Tendons: These muscles stabilize the patella, but imbalances or weakness here can contribute to PFPS.
Patellar Tendon: This tendon connects the patella to the shinbone (tibia) and helps extend the knee.
Retinaculum: Fibrous bands that stabilize the patella. Tightness or laxity can disrupt patellar movement.
Cartilage: The undersides of the patella and femur are covered in cartilage for smooth movement. Damage here often leads to PFPS.
Synovial Tissue: This tissue produces lubrication for the joint. Inflammation in this area can contribute to discomfort.
Hip and Ankle Alignment: The alignment and strength of your hips and ankles directly affect knee mechanics. Weak hip muscles or foot overpronation can aggravate PFPS.
Since PFPS is often caused by a mix of factors rather than just one issue, treating it requires a holistic approach. Addressing muscle imbalances, movement patterns, and structural concerns can make a big difference in relieving pain and restoring proper knee function.
Diagnostic Evaluation
The diagnostic process for PFPS is multi-faceted, combining a detailed patient history with a comprehensive physical examination.
Knee Examination - Orthopaedic Testing
This video provides a comprehensive guide to diagnosing common causes of knee pain through various orthopedic examination techniques.
Lower Limb Neuro Examination
The lower limb neurological examination assesses the motor and sensory neurons supplying the lower limbs to detect any nervous system impairment. This examination is used both as a screening and investigative tool.
Peripheral Vascular Examination
The peripheral vascular examination is a physical exam that evaluates the circulatory system outside of the heart and lungs. This exam is important in diagnosing and managing peripheral vascular diseases such as arterial occlusion, aneurysms, and venous insufficiency.
Imaging Modalities
X-rays:
Role: X-rays primarily provide a two-dimensional image of the bony anatomy of the knee joint, making them the initial choice for imaging in PFPS[9].
Rationale: X-rays are beneficial in assessing the overall alignment of the patella within the trochlear groove of the femur, evaluating for potential bone abnormalities or fractures, and checking for signs of osteoarthritis, such as reduced joint space.
Limitation: While X-rays are useful for evaluating the bone structure, they do not provide detailed information about soft tissues, including the cartilage, ligaments, and tendons.
Magnetic Resonance Imaging (MRI):
Role: MRI is employed to visualize soft tissue structures in the knee joint when a more comprehensive evaluation is required.
Rationale: MRIs offer a detailed view of the cartilage under the patella and on the femur, the quadriceps and patellar tendons, and the medial and lateral retinacula. They can detect soft tissue abnormalities contributing to PFPS, such as cartilage wear, inflammation, or damage to the tendons or ligaments.
Added Benefit: MRIs are instrumental in ruling out other knee pathologies that may mimic PFPS, such as meniscal tears or ligamentous injuries.
Differential Diagnosis
Distinguishing Patellofemoral Pain Syndrome (PFPS) from Other Knee Conditions
The knee is a complex joint, and many conditions can present with similar symptoms to Patellofemoral Pain Syndrome (PFPS). That’s why it’s essential to consider a range of possible diagnoses when evaluating someone with knee pain. Here are some common conditions that can be mistaken for PFPS:
Iliotibial Band Syndrome (ITBS):
ITBS occurs when the iliotibial band, a thick band of tissue running along the outside of the leg, becomes inflamed. This condition often affects runners and active individuals, causing lateral knee pain that can be confused with PFPS.
Key Difference: ITBS causes pain on the outside of the knee, while PFPS typically involves pain at the front of the knee.
Meniscal Injuries:
The menisci are cartilage discs that cushion the knee joint. A meniscal tear can lead to pain, swelling, and instability, which may resemble PFPS symptoms.
Key Difference: Meniscal injuries often cause mechanical symptoms like knee locking, catching, or a feeling that the knee might give way. Pain is usually more localized and can worsen with pressure on the joint.
Patellar Tendinitis (Jumper’s Knee):
Patellar tendinitis involves inflammation of the patellar tendon, which connects the kneecap to the shinbone. It causes anterior knee pain, much like PFPS.
Key Difference: Patellar tendinitis pain is concentrated just below the kneecap and is triggered by explosive movements like jumping or sprinting.
Osteoarthritis (OA):
OA is a degenerative joint disease that can affect the knee, causing pain, stiffness, and reduced function—symptoms that may mimic PFPS.
Key Difference: OA is more common in older individuals and is often associated with morning stiffness that improves with movement. X-rays can confirm OA by showing joint space narrowing and other degenerative changes.
A careful and thorough evaluation is critical to distinguishing PFPS from these other conditions. Understanding the subtle differences allows healthcare providers to choose the most effective treatment plan for each patient, ensuring the best path to recovery.
Treatment & Exercise
Managing PFPS effectively requires an integrative approach that combines manual therapy with a personalized exercise program. This method is at the core of the Motion Specific Release (MSR) philosophy, which focuses on releasing tension, improving mobility, and restoring function.
In the demonstration videos, you’ll see practical examples of MSR techniques along with targeted exercises designed to reduce pain, improve strength, and promote healing for those dealing with PFPS. By combining hands-on therapy with functional exercises, this approach ensures a well-rounded, tailored treatment plan to help you regain mobility and get back to your favorite activities.
Knee Release Protocol
In the accompanying video, Dr. Abelson demonstrates an effective knee release protocol using Motion Specific Release (MSR) techniques. These procedures address the localized area of pain and the broader kinetic chain, contributing to a more comprehensive treatment approach.
4 Point MSR Knee Protocol
Effective Motion Specific Release knee mobility procedures are demonstrated in this video, which effectively addresses the body's entire kinetic chain. The femur, tibia, and patella, as well as many muscles and ligaments, make up the complicated structure of the knee joint.
Fascial Expansion: The MSR Knee Pain Protocol
Utilizing fascial expansions in knee pain management merges contemporary insights into fascia, kinetic chain relationships, and acupuncture principles. This approach effectively treats Runner's Knee (Patellofemoral Pain Syndrome) by improving joint function and reducing discomfort. The MSR protocol focuses on alleviating tension in the quadriceps and correcting imbalances in the kinetic chain that contribute to patellar misalignment. By enhancing fascial health and biomechanics, the MSR techniques help reduce inflammation, alleviate pain around the kneecap, and improve mobility, offering a holistic treatment that addresses underlying causes and promotes tissue repair.
Exercises
Quadricep Lacrosse Ball Release Video
Many people have tight, restricted, and overactive quadriceps. This is because most people overuse their quadriceps and adductors to perform lower extremity motions, such as squats, when they should be using their gluteals and hamstrings. This results in the development of muscle imbalances (strongly restricted quadriceps and weak hamstrings).
4 Point Band Leg Strengthening Exercise Video
This TheraBand exercise routine is specifically designed to target and strengthen four crucial muscle groups: Adductor, Abductor, Flexor, and Extensor muscles. These muscle groups play a vital role in maintaining stability, facilitating movement, and enhancing overall functional performance.
Why Choose Our Approach for Patellofemoral Pain Syndrome (PFPS) Treatment
Our comprehensive approach to treating Patellofemoral Pain Syndrome (PFPS) consistently achieves a 90% success rate in reducing knee pain and restoring function. Here's why our method is so effective:
Established Expertise: Developed by Dr. Brian Abelson, our Motion-Specific Release (MSR) methodology is backed by over 30 years of clinical experience and the successful treatment of more than 25,000 patients, ensuring the highest standard of care.
Thorough Assessments: We conduct in-depth evaluations to identify all contributing factors, including muscle imbalances, improper patellar tracking, and biomechanical issues that often lead to PFPS.
Advanced MSR Techniques: Our MSR procedures precisely target fascial restrictions, muscle tightness, and structural misalignments, offering focused relief and improved mobility.
Customized Exercise Programs: We design individualized exercise routines to strengthen the quadriceps, improve knee stability, and enhance overall knee function, ensuring a comprehensive recovery.
Logical, Evidence-Based Approach: Our treatment plans integrate manual therapy with exercise and supportive measures, providing a well-rounded and lasting solution to PFPS.
Choose our proven, patient-centered approach for long-term relief from Patellofemoral Pain Syndrome. Take your first step toward a pain-free, active lifestyle with confidence.
References
Crossley KM, Stefanik JJ, Selfe J, et al. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016;50(14):839-843.
Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40(2):42-51.
Petersen W, Ellermann A, Gösele-Koppenburg A, et al. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2264-2274.
Witvrouw E, Callaghan MJ, Stefanik JJ, et al. Patellofemoral pain: consensus statement from the 3rd International Patellofemoral Pain Research Retreat held in Vancouver, September 2013. Br J Sports Med. 2014;48(6):411-414.
Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Risk factors for patellofemoral pain syndrome: a systematic review. J Orthop Sports Phys Ther. 2012;42(2):81-94.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2nd ed. New York, NY: McGraw Hill Medical; 2008.
Cook C, Hegedus E. Orthopedic Physical Examination Tests: An Evidence-Based Approach. 2nd ed. Pearson; 2013.
Magee DJ. Orthopedic Physical Assessment. 6th ed. Saunders; 2014.
Fredericson M, Yoon K. Physical examination and patellofemoral pain syndrome. Am J Phys Med Rehabil. 2006;85(3):234-243.
Brukner P, Khan K. Clinical Sports Medicine. 4th ed. McGraw-Hill; 2012.
Crossley K, Bennell K, Green S, et al. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. Am J Sports Med. 2002;30(6):857-865.
Davis IS, Powers CM. Patellofemoral pain syndrome: proximal, distal, and local factors, an international retreat, April 30-May 2, 2009, Fells Point, Baltimore, MD. J Orthop Sports Phys Ther. 2010;40(3):A1-A16.
Lack S, Barton C, Sohan O, Crossley K, Morrissey D. Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis. Br J Sports Med. 2015;49(21):1365-1376.
Smith BE, Selfe J, Thacker D, et al. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PLoS One. 2018;13(1):e0190892.
Neal BS, Lack SD, Lankhorst NE, et al. Risk factors for patellofemoral pain: a systematic review and meta-analysis. Br J Sports Med. 2019;53(5):270-281.
Boling M, Padua D, Marshall S, et al. A prospective investigation of biomechanical risk factors for patellofemoral pain syndrome: the Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) cohort. Am J Sports Med. 2009;37(11):2108-2116.
Petersen W, Rembitzki IV, Liebau C. Patellofemoral pain in athletes. Open Access J Sports Med. 2017;8:143-154.
Collins NJ, Barton CJ, van Middelkoop M, et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med. 2018;52(18):1170-1178.
Crossley KM, van Middelkoop M, Callaghan MJ, et al. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). Br J Sports Med. 2016;50(14):844-852.
Rixe JA, Glick JE, Brady J, Olympia RP. A review of the management of patellofemoral pain syndrome. Phys Sportsmed. 2013;41(3):19-28.
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
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