Patellofemoral pain syndrome (PFPS) can be treated in many ways.
About Patellofemoral Pain Syndrome
Patellofemoral syndrome is runner’s knee.1 The pain is located in the front of the knee in this disorder, which is most likely to affect athletes as well as manual laborers and teens. PFPS can be “caused by wearing down, roughening, or softening of the cartilage under the kneecap” due to injury, overuse, excessive weight, or a kneecap that is improperly aligned. The latter condition is called patellar tracking disorder. With PFPS, patients experience pain when squatting, jumping, sitting with the knees bent, or using stairs. The knee may also buckle, a situation in which the knee “gives way” or does not support the body’s weight. A grinding, popping, or catching sensation is also possible. Doctors can determine if a patient has patellofemoral pain syndrome with an examination or imaging tests.2 The sports most likely to trigger this condition are running, cycling, and basketball. This disorder can be gradual or due to a single incident. It may arise as a result of a change in the training regimen that increases the intensity, time, or distance. Wearing the wrong footwear can make the situation worse. The most common symptoms of PFPS are knee pain, joint noises, and giving-way of the knee. The typical causes are not only the increased activity and patellar misalignment, but also quadriceps imbalance, and “tight anatomical structures… retinaculum or iliotibial band”. Bone bruises may occur, and some patients could have fractures, tumors, or osteoarthritis.3
Traditional Patellofemoral Pain Syndrome Treatment Options
There are several ways in which PFPS can be treated. Patellofemoral pain syndrome surgery is not the only option. Patients should avoid squatting, sitting, or kneeling for long period of time. If the patient uses a bicycle, the seat should be at the proper height and the resistance should not be too strong, and the “legs should not be fully extended at the lowest part of the pedal”. Bent knee exercises, such as deep knee bends or squats should be avoided. These types of activities can make the symptoms worse. Some patients may benefit from taping or using a patellofemoral pain syndrome brace. To decrease swelling and pain, NSAID medications could be advised, along with ice and rest. Patellofemoral pain syndrome exercises might be prescribed, such as stretching to improve flexibility and “straight-leg raises…to strengthen the quadriceps muscle”. Some patients can benefit from patellofemoral pain syndrome physical therapy.4 Exercise could be used in addition to other treatments such as electromyographic biofeedback or electrostimulation. There is evidence in the support of quadriceps exercise because the quadriceps muscles help “stabilize the patella”. There is also some evidence that suggests that patients could benefit from “hip abductor and external rotator strengthening, as well as exercises targeting hip flexion and hip extension”. Proper form is important when doing any exercises, so as to avoid further injury. Since “inflexibility has often been cited as a source of patellofemoral pain syndrome”, it may be important to stretch the lateral knee. Taping and bracing might not be as effective as quadriceps exercises; however, “arch supports and custom orthotics may also help to improve lower extremity biomechanics”. Surgery should be avoided unless the case is extreme.5
Alternative and Home Remedies
Patients must first stop activities that hurt the knee. Changing the training routine or trying low-impact activities such as swimming and biking could be helpful. Losing weight is crucial, if being overweight has caused the excessive knee pressure. RICE (rest, ice, compression, and elevation) could provide relief to patients. When using ice, the cold packs can be put on for up to 20 minutes at a time, but it should not be placed right on the skin. Compression can be accomplished by wrapping the knee with “an elastic bandage, leaving a hole in the area of the kneecap”.6 Patients can work on their weak quadriceps, tight iliotibial bands, tight hamstring and calf muscles, and weak hip muscles. Patients can be trained in exercises, and they should be able to “manage physical therapy on their own…20 minutes per day”. It could take over six weeks to see improvement. A knee brace is no substitute for therapeutic exercises, and they should be “reserved for use in patients with lateral subluxation that can be seen with the naked eye”. Taping methods, which offer short-term relief, should be taught to the patient by a trained professional. As noted before, seeking out proper footwear can also provide relief.7 Myofascial release, applied to the “rectus femoris” is another treatment option, which would be offered by chiropractors. In addition, Active Release Technique® (ART®) from a chiropractor may help. Joint mobilization (a manual therapy) of the ankle and foot is another treatment modality. Chiropractors can also provide lifestyle and exercise advice. Running is like “a series of single leg squat jumps…repetitively”, so controlling the hip is important, for example.8 Patients with patellar tracking disorder who have been prescribed RICE, NSAIDs, taping, or a brace may also want to consider orthotics. An exercise program would also be prescribed to increase the flexibility and strength of the hips and legs.9
Recent research suggests that tart cherry juice alleviates pain and inflammation, perhaps more than NSAIDs. This is important because long-term NSAID use can lead to ulcers, stroke, kidney failure, and heart attack. Tart cherries, like NSAIDs, also inhibit the COX enzymes, but cherries have “high levels of flavonoids and anthocyanins that have anti-inflammatory properties”. Cherries also have melatonin, which helps regulate the internal clock, promoting better sleep. The cherries used in research are tart Montmorency cherries, in a juice form that is the “equivalent of about 45-50 cherries per drink and 90-100 cherries total per day”. If taken in the form of a concentrate, only 1 ounce is needed, but if it is in a juice blend, an 8 ounce serving would be required. If a patient uses tart cherry juice, they will need about four days of a “loading period”, taking the juice two times per day, to build up the antioxidant levels before exercising.10