Treatment of PFPS

Patellofemoral Pain Syndrome (PFPS) is the medical name that is often referred to as chondromalacia or runner's knee.  While common, treatment of PFPS can be frustrating and time consuming.  Recovery may take weeks or even months, but with the right steps, most people find relief from PFPS.


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PFPS is the result of irritation to the patellofemoral joint.  While many people blame the cartilage of the kneecap for the problem (chondromalacia) the problem is known to be more complex.  Cartilage does not have nerve endings, so the pain is likely coming from the bone supporting the cartilage and the surrounding soft-tissues. 

The first step in treatment of these types of overuse injuries is to rest the painful knee.  Avoiding activities that cause pain can help reduce inflammation.  This means avoiding some sports, stair/hill climbing and descending, and sitting with your knees bent for lengthy times.


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Ice is also an effective anti-inflammatory and also helpful at alleviating pain.  Ice application can help reduce symptoms of PFPS.  Ice can be applied frequently, but it is important to take regular breaks from icing to prevent injury from prolonged ice application.

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Anti-Inflammatory Medications

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Anti-inflammatory medications can also be helpful for people with inflammatory conditions.  While the effects may only persist while taking the medications, it can be helpful when the symptoms are most painful.  It is important to recognize that anti-inflammatory treatments are only effective at reliving symptoms, and prolonged relief is unlikely unless the cause of PFPS is addressed.

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Physical Therapy

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Physical therapy is the mainstay of treatment for PFPS.  In order for PT to be effective, you will need to dedicate time and effort to change and improve your body's joint mechanics with the help of a physical therapist.  It is not reasonable to expect PT to be helpful if you aren't compliant with the program including the effort and regularity that are necessary for success.

Physical therapists are becoming increasingly aware that PFPS is a problem of lower-extremity mechanics, and not simply a problem of the knee or the foot, etc.  In order to address the problem effectively, the dynamic neuromuscular control of the entire lower extremity should be addressed--a good physical therapist can help significantly with this!

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Hip and Core Strengthening

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The best exercises for PFPS are generally focused on the hips and the core.  It is well known that body movements begin in our core, and move outwards along the extremity.  Poor core strength needs to be addressed first to expect good results for rehab of knee joint mechanics.

The best PT programs that have been studied scientifically have focused on strengthening of the muscles that surround the hip joint.  Hip abductor and hip flexor strengthening have been shown to be important when rehabbing PFPS.

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Not VMO Strengthening!

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One of the most commonly recommended treatments for PFPS is to strengthen the VMO (vastus medialis obliquus muscle), the muscles on the inner side of the thigh.  The theory is, that selective strengthening of these muscles will help improve the movement and stability of the kneecap.  While VMO strength has been shown to correlate with PFPS, it is unclear if the loss of strength is the cause or effect of PFPS.

The problem is, selective strengthening of the VMO has never been shown to be possible, and the exercises people recommend (straight leg raises, for example) haven't been shown to help with PFPS.  There is very good data to support the focus of therapy on hip flexors and abductors, and core strength and stability. 

Returning to Sports

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One of the mistakes I often see athletes make is trying to rehab their PFPS while also continuing high intensity sports.  While I believe that sports don't necessarily need to be stopped completely, it is unreasonable to expect an athlete to both focus on sports and on rehab at the same time.  Effective rehab must be the athlete's priority--if it's the other way around, the success of PT is likely to be limited.


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Treatment with surgery used to be common, but is much less likely to be needed as doctors have learned more about this condition.  With proper rehabilitation, most patients find good treatment results without surgery, and the small number of patients who actually benefit from surgical treatment is small. 

Historically, the surgical procedure called a a lateral release was performed for many people with symptoms of patellofemoral pain.  We know that the actual group of patients who benefit from this procedure is small, and doctors have learned how to appropriately predict which patients might need this type of surgery.  Arthroscopic surgery can be helpful for treatment of more severe cartilage damage, and it can also help treat conditions that may be seen in patients with chondromalacia such as plica syndrome and patellar subluxation.


Post WR. "Anterior Knee Pain: Diagnosis and Treatment" J Am Acad Orthop Surg December 2005 vol. 13 no. 8 534-543.

Earl JE and Hoch AZ. "A Proximal Strengthening Program Improves Pain, Function, and Biomechanics in Women With Patellofemoral Pain Syndrome" Am J Sports Med. January 2011 39:154-163

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