The current management of patients with patellofemoral pain from the physical therapist's perspective

Abstract

Patellofemoral pain (PFP) is a common diagnosis that includes an amalgam of conditions that are typically non-traumatic in origin and result in peripatellar and/or retropatellar knee pain. The purpose of this review is to provide an overview of the physical therapist's management, including the evaluation and treatment, of the patient with PFP. A thorough history is critical for appropriately diagnosing and optimally managing PFP; the history should include the date of symptom onset, mechanism of injury and/or antecedent events, location and quality of pain, exacerbating and alleviating symptoms, relevant past medical history, occupational demands, recreational activities, footwear, and patient goals. Physical examination should identify the patient's specific impairments, assessing range of motion (ROM), muscle length, effusion, resisted isometrics, strength, balance and postural control, special tests, movement quality, palpation, function, and patient reported outcome measures. Objective assessments should guide treatment, progression, and clinical decision-making. The rehabilitation program should be individually tailored, addressing the patient's specific impairments and functional limitations and achieving the patient's goals. Exercise therapy, including hip, knee, and core strengthening as well as stretching and aerobic exercise, are central to the successful management of PFP. Other complimentary treatments may include patellofemoral and tibiofemoral joint mobilizations, patellofemoral taping, neuromuscular training, and gait retraining. Appropriate progression of interventions should consider objective evaluations (e.g., effusion, soreness rules), systematic increases in loading, and the chronicity of symptoms. Although short-term changes or reductions in movement often are necessary in a protective capacity, the persistence of altered movement is a key characteristic of chronic pain, which may be managed in part through emphasis on function over symptoms, graded exposure, patient education, and perhaps referral. PFP etiology is largely movement related and a comprehensive conservative treatment using movement can be successful.

Keywords: Patellofemoral joint; patellofemoral pain (PFP); physical therapy; rehabilitation.

Figure 1

Quadriceps strength may be evaluated isometrically using an electromechanical dynamometer during with an electrical burst superimposition technique (32) to assess muscle activation. Clinicians may evaluate the (most) involved limb first to determine the angle of knee flexion that is pain-free or least provocative and subsequently evaluate the contralateral limb at the same angle of knee flexion for comparison. Patellar taping may be used to alleviate pain.

Figure 2

The patients stand on the involved limb on a 15-cm box (A) to begin the modified step test. We document the angle at which the patient experiences pain and the patient’s numeric pain rating both before (B) and after (C) applying patellar taping.