{"id":216749,"date":"2022-09-19T17:50:07","date_gmt":"2022-09-19T17:50:07","guid":{"rendered":"https:\/\/wandsworthphysiotherapy.co.uk\/the-management-of-patello-femoral-pain\/"},"modified":"2025-10-28T12:15:58","modified_gmt":"2025-10-28T12:15:58","slug":"management-of-patella-femoral-pain","status":"publish","type":"post","link":"https:\/\/wandsworthphysiotherapy.co.uk\/management-of-patella-femoral-pain\/","title":{"rendered":"The management of patella-femoral pain"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\"><span style=\"color: #339966;\"><strong>What is patella-femoral pain (PFP)?<\/strong><\/span><\/h1>\n\n\n\n<p class=\"wp-block-paragraph\"><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/H9OhQ9HSsVw\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patella-femoral pain in an umbrella term that encompasses multiple pathology such as cartilage lesion and patella <a href=\"https:\/\/www.nhstayside.scot.nhs.uk\/WorkingWithUs\/ReferralHelpSystem\/PROD_354627\/index.htm\" target=\"_blank\" rel=\"noopener\">bone marrow oedema<\/a> and progression of synovitis. There may be fissuring and fibrilation of the articular cartilage of the trochlea and \/ or patella cartilage.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The presentation of an obese teenage girl with hypermobility \/ hyperextension will need to be managed differently to a thin 50-year-old distance runner.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There may be crepitus as well as pain, however cartilage is a-neural so cartilage fibrillation won\u2019t cause pain. <a href=\"https:\/\/www.nhs.uk\/live-well\/exercise\/knee-pain-and-other-running-injuries\/\" target=\"_blank\" rel=\"noopener\">Anterior knee pain<\/a> is non-descript and chodromalecia patella is a descriptive term for retropatella fibrillation and fissuring graded 1-4. This condition is now known as patella-femoral pain.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Classic signs include pain with prolonged sitting \u2013 cinema sign. This type of PFP is a compression issue not a stability or movement issue and may be due to tight quads. If crossing the legs makes it worse this may be due to compression of the patella laterally or superior lateral fat pad.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2023\/09\/photo_0171-1024x683.jpg\" alt=\"Patella-femoral pain and chondromalacia patellae\" class=\"wp-image-2578\" srcset=\"https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2023\/09\/photo_0171-1024x683.jpg 1024w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2023\/09\/photo_0171-300x200.jpg 300w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2023\/09\/photo_0171-768x512.jpg 768w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2023\/09\/photo_0171-1536x1025.jpg 1536w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2023\/09\/photo_0171.avif 1920w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span style=\"color: #339966;\"><strong>What are the symptoms of patella-femoral pain?<\/strong><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Diffuse anterior \/ retro-patella pain. Can refer to popliteal fossa<\/li>\n\n\n\n<li>Localised tenderness unusual<\/li>\n\n\n\n<li>Aggravated by stairs, squats, sit to stand<\/li>\n\n\n\n<li>Worse with flexion \/ seated flexion (cinema sign) \/ loaded flexion<\/li>\n\n\n\n<li>Likes to stand, be in hyper-extension<\/li>\n\n\n\n<li>Dislikes heels<\/li>\n\n\n\n<li>Rarely swollen<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Pain with walking up hill or downstairs could be due to DF and calf length or poor eccentric strength of the quads, up-stairs could be more due to quad and glute strength. PFP can be accompanied by crepitus \u2013 cracking and creaking of the patella on movement.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This can often be more of a bother than the pain and may also cause a lot of fear avoidance in people. However, it is quite normal, and we need to separate the pain from the noise. We will very often get the pain better, but the noise may remain and is not causing damage.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"color: #339966;\">It can be:<\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fluid moving through fibrillated cartilage<\/li>\n\n\n\n<li>Cavitation of gas within the PFJ<\/li>\n\n\n\n<li>Patella clunking around<\/li>\n\n\n\n<li>Friction<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span style=\"color: #339966;\"><strong>Risk factors for patella-femoral pain include:<\/strong><\/span><strong>&nbsp;<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Excess PFJ loading (obesity \/ training load)<\/li>\n\n\n\n<li>Pronated foot type<\/li>\n\n\n\n<li>Anteverted femur<\/li>\n\n\n\n<li>Poor proximal control around the glutes<\/li>\n\n\n\n<li>Muscle imbalance \u2013 tight calf and quads and weak quads<\/li>\n\n\n\n<li>Hypermobility<\/li>\n\n\n\n<li>Patella Alta<\/li>\n\n\n\n<li>Obesity (increased cytokine production)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Patella Alta describes the patella sitting too high. This is a congenitally longer patella tendon. The length of the patella and patella tendon should be 1:1. Going into knee flexion takes longer for the patella to descend into the trochlea and is therefore more unstable. Target the unstable position with strength exercises \u2013 0-40d. Use isometrics and avoid excess pain.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span style=\"color: #339966;\"><strong>Treatment for patella-femoral pain<\/strong><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">First, have an assessment such as a <a href=\"https:\/\/wandsworthphysiotherapy.co.uk\/runners-clinic\/\">Run Fit<\/a> or <a href=\"https:\/\/wandsworthphysiotherapy.co.uk\/sports-injury-clinic\/\">Sports Injury Assessment and Treatment<\/a>. Based on what we find we may recommend strengthening the VMO and quads. Hypertrophy causes a change in pennation angle and greater muscle fibre attachment to the patella.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This helps to medialise and stabilise the patella. Muscle stimulation whilst doing strength exercises also increases pennation angle of VMO on the patella and has a greater effect than strengthening alone.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Obesity not only increases mechanical load through the knee, but obesity increases pro-inflammatory cytokines into the body. The fat pad can feed inflammatory chemicals directly into the knee joint and can exacerbate OA. Synovitis increased in obese people and cartilage lesions greater in the PFJ than the TFJ.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span style=\"color: #339966;\"><strong>Ultrasound guided injections for patella-femoral pain<\/strong><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">We can use <a href=\"https:\/\/wandsworthphysiotherapy.co.uk\/ultrasound-guided-injections\/\">ultrasound guidance to inject either steroid, PRP or hyaluronic acid<\/a> in to the knee joint to help settle PFP that is not responding to physiotherapy or that shows mild to moderate arthritic changes on x-ray or MRI. We offer our specialist knee pain clinic at our Wandsworth Town, Clapham Junction and Battersea Nine Elms and Vauxhall locations, and our complete knee assessment at Wandsworth Town. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/eLjoXw07TN0\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Patello-femoral pain in an umbrella term that encompasses multiple pathology such as cartilage lesion, patella bone marrow oedema and progression of synovitis.<\/p>\n","protected":false},"author":14,"featured_media":216694,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[344],"tags":[475,359,476,361],"class_list":["post-216749","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sports-injury","tag-knee-cap-pain","tag-knee-pain","tag-patella-femoral-pain","tag-ultrasound-guided-injections"],"acf":[],"_links":{"self":[{"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/posts\/216749","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/users\/14"}],"replies":[{"embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/comments?post=216749"}],"version-history":[{"count":0,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/posts\/216749\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/media\/216694"}],"wp:attachment":[{"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/media?parent=216749"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/categories?post=216749"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/tags?post=216749"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}