Patellofemoral Pain Syndrome

Loaded knee flexion

A frequent problem affecting adults and adolescents characterised by diffuse retropatellar pain induced by and limiting activities of daily living that load a flexed knee. Such activities include ascending and descending stairs, squatting and prolonged sitting” Bolga and Malone, (2005)

Underlying pathology:

  • Controversy in literature: overloaded with theories.
  • Subchondral bone deformation(Goodfellow et al, 1998, Naslund et al, 2005)
  • Intermedullary pressure changes (Arnoldi, 1991)
  • Lateral retinacular neuroma formation (Sanchis-Alfonso et al, 1998)
  • Vascular dysfunction (Sanchis-Alfonso et al, 2007, Selfe – work ongoing)
  • The tissue homeostasis theory/the biological inflammatory cascade (Dye et al, 1999

Risk factors:

  • Conflicting evidence of delayed onset VMO (Selfe, 2004).
  • VMO onset delay in runners with PFPS (Ng et al, 2011).
  • VMO-VL timing rations vary between healthy subjects and patients (Selfe, 2004).
  • Effusion inhibits quads: VM (Torry, 2000).
  • Reduced quads flexibility, VM reflex response time, explosive strength and vertical jump ability (Witrouw, 2000).
  • Weakness of hip lateral rotators and abductors (Robinson, 2007 and Ireland, 2003).
  • PFPS subjects sig difference in ITB length in symptomatic and asymptomatic sides(Hudson and Darthuy, In Press)
  • ITB tightness increases pressure on lateral patella facet (Merican et al, 2009)
  • PFPS subjects had significantly shorter hamstrings than asymptomatic controls (White et al, In Press)


  • Poor prediction of recovery if pain persists for 2 years (Price, 2000).
  • Combination of CKC and OKC exercises required: quads, hip lat rot and abd.
  • Flexibility: quads and hams.
  • OKC avoided in 1st 30* flex (Doucette, 1996).
  • Exercises can be performed in controlled pain.
  • Proprioception (Callaghan,  2008, 2010, 2011).
  • Physiotherapy mobilisation and manipulation.
  • Acupuncture.
  • Taping/bracing .
  • Combined approach(Mason, 2010).
  • Orthotics (Vincenzino, 2010 and Barton, 2009).

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