Patellofemoral Stress Syndrome: First Steps to Treatment

Photo of a tennis player holding a painful knee.
Knee pain from PFSS requires you to take action right away to get back in the game.. Westend61/Getty Images

If you have knee pain due to patellofemoral stress syndrome (PFSS), then you understand how the pain can limit your ability to run, walk, or climb and descend stairs. The pain may seem to come on for no apparent reason, and it may take quite a bit of work to get back to normal.

If you have PFSS, there are a few things you should stop doing, like avoiding exercise or ignoring the pain. There are also a few things that you should do right away if you develop pain around your kneecap that limits you ability to enjoy your normal activities.

If you develop pain in the front of your knees around your kneecaps, then you might have PFSS. There are a few things that you should start doing right away to quickly get on the road to recovery and back to your normal activities.

  1. Don't panic. When pain strikes, don't panic. Most cases of PFSS are caused by simple bio mechanical faults and can be managed with a few stretches and strengthening exercises. When PFSS pain strikes, relax and understand that the symptoms will be short lived.
  2. Check in with your doctor. If you are feeling pain in your kneecaps, it is probably a good idea to visit your doctor. He or she can examine your knee to ensure that the PFSS diagnosis is correct and rule out any more sinister or dangerous problem with your knee. Once you visit your doctor, you can be on the road to treating your PFSS.
  3. Visit your physical therapist for a complete assessment of your condition. Patellofemoral stress syndrome of the knee is often caused by tightness or weakness (or a combination of both) in muscle groups around your knees or hips. Your physical therapist can perform a complete musculoskeletal assessment to determine the cause of your PFSS, and exercises can be prescribed to help manage your condition.
  1. Start stretching. Sometimes, PFSS is caused by flexibility issues with the muscles around your knee or hip. Stretches for your calf, quadriceps, hamstrings, or iliotibial band my be required to help ensure that your kneecap tracks properly in the groove at the end of your thigh bond in your knee joint. Your PT can help you determine which muscles groups may be at fault and should be the focus of your PFSS stretching routine.
  1. Start strengthening your quadriceps. Evidence suggests that weakness in a specific area of your quadriceps muscle may lead to PFSS. This area, called the VMO, typically responds well to exercises, like quad sets or short arc quads, to get back to optimal function. Start working on strengthening your quadriceps to get your PFSS symptoms under control.
  2. Work on strengthening your hips. Research suggests that PFSS--and other painful knee conditions--may be caused by weakness in your hips. Your hip controls the position of your knee when you are walking and running, and weakness in your gluteus muscles may cause your kneecap to move out of place during these activities. 
  3. Perform balance exercises. Many patients with PFSS exhibit balance and proprioception impairments. Check in with your physical therapist to determine if your balance may be one cause of your PFSS, and start working on specific exercises to improve your balance and overall awareness of your hip and knee position.
  4. Be patient. Treating PFSS takes time, and your symptoms of knee pain and limited activity may last for up to 8 weeks. Be patient with your condition, and stay focused on working on improving the impairments identified by your PT to properly treat your PFSS>

    Patellofemoral stress syndrome can be a difficult condition to treat, as many different factors can lead to increased stress and pain in your kneecap. The best course of treatment is to undergo a complete musculoskeletal assessment from your physical therapist and get working on the impairments identified during that evaluation.

    By working hard in physical therapy and with your PFSS home exercise program, you can be sure to quickly and safely get back to your normal, pain free activities.

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