Guidelines for Patellofemoral Pain

The presence of pain surrounding the knee cap or behind the kneecap is commonly diagnosed
as ‘patellofemoral pain’ (PFP) and is typically aggravated by going up and down stairs,
squatting, or long periods of sitting. This diagnosis is made in the absence of other pathologies
present at the knee, such as an ACL tear. A newly released paper synthesizing the most
up-to-date evidence on appropriate treatment of patellofemoral pain recently hit the Internet with
some specific guidelines.

The clinical guidelines dive into the predisposing factors that are associated with PFP. The
evidence does not show a high correlation of PFP with certain ages, BMIs, heights, or Q angles
(the angle of your pelvis in relation to your knee cap and lower leg). However, isometric
quadriceps weakness and hip muscle weakness were found in those with PFP. The amount of
load placed on the knee, i.e. how much of a repetitive activity one is performing, increases risk
for PFP due to the lack of time for tissue healing to occur.

The guidelines then provide analyses of various conservative treatment options based on
efficacy. Exercise is the most highly recommended treatment for people with patellofemoral
pain. Specific exercises tailored to your current strength abilities that focus on improving
strength and neuromuscular control of the hip and knee are paramount. Dosing, or amount and
frequency of these exercises, must be addressed. This makes it important to work with a
healthcare provider in addressing your knee pain. Evidence shows that patients reported
improved function and decreased pain in the short, medium, and long term who performed hip
and knee strengthening exercises. The article also mentions blood flow restriction training as
an option during strengthening.

Acupuncture is also supported in this clinical review for treatment of this type of knee pain.
Acupuncture has little associated negative side effects and is effective in helping reduce
symptoms related to many types of pain. Moxa is an adjunct used by our acupuncturist to
reduce swelling and inflammation by penetrating the tendon or muscle with heat. Electrical
stimulation with acupuncture needles is also effective at stimulating the neural pathway to the
quadriceps muscle group. This will help improve function and control of the quadriceps muscle
which is necessary during rehabilitation for this issue.

One intervention not supported in the literature is the use of braces or sleeves in the treatment
of patellofemoral pain. This makes sense, as braces or sleeves are typically used for providing
external stability to a joint or compression to reduce swelling. Braces and sleeves may be more
appropriate when more control is needed surrounding a joint, such as following an ACL tear or

These guidelines provide us with valuable information on how to address and treat anterior knee
pain. At Repair, our physical therapists use the most current evidence to evaluate and create an
appropriate, individualized treatment program for you. We offer acupuncture, blood flow
restriction training, and other services to give you the most effective and positive rehabilitation
journey. Don’t ignore your pain…call to make your appointment today!