Treatment of patellofemoral pain should involve reducing the initial pain and swelling as well as identifying and addressing the possible causes and correcting them.
Aims of rehabilitation
The following guidelines are for information purposes only. We recommend seeking professional advice. The aims of a patelliofemoral pain rehab program are to:
- Decrease pain and inflammation
- Strengthen the weakened muscles of the knee and hip
- Increase flexibility of the tight muscles
- Address any biomechanical issues
- Gradually returning to full fitness
Reducing pain and inflammation
Rest from activities that aggravate the injury. As a general rule, if it hurts or is made worse then don't do it. Apply cold therapy or ice but do not apply ice directly to the skin as this may cause ice burns. Ice may be applied for 15 minutes every 2 hours initially reducing frequency as symptoms allow. Compression, particularly in conjunction with cold therapy can help in reducing swelling.
Using a patellofemoral pain syndrome taping technique can have an instant effect in relieving pain as the kneecap is pulled away from the site causing pain. The purpose of taping is to reduce pain and allow muscle strengthening exercises to be done correctly. If the athlete has pain on normal daily activities then taping should be applied all day until there is no pain. If there is patella pain only on sports specific activities or muscle strengthening exercises then patella taping should only be done for those exercises.
Wearing a patellofemoral pain syndrome brace can also relive symptoms in the same way as the taping does. A good brace will have straps or similar to control the position of the kneecap.
Identify possible causes
It is essential the factors which help cause the pain in the first place are identified and addressed. These include external factors such as type of shoe, over training or training surfaces as well as internal factors such as weak muscles or biomechanical factors. See symptoms and diagnosis for more detailed analysis of the causes.
The aim of exercises is usually to strengthen the vastus medialis muscle on the inside of the knee and ensure it contracts at the same time as the other quadriceps muscles. This should help pull the kneecap inwards or medially and allow it to track normally on the tibia bone. Isometric or static exercises should be done first progressing to weight bearing exercises with the foot in contact with the ground, which are thought to be most beneficial.
Patella taping can be done to prevent exercises being painful and assist with correct tracking of the patella. It is important that the athlete can feel the vastus medialis muscle contacting during strength exercises and beginners may need to actually feel the muscle with their hand as it contracts.
Stretching and sports massage
Exercises to stretch the structures on the outside of the knee as well as the hamstrings and calf muscles should be done. This is just as important as strengthening the inside. Tight lateral structures will not allow the kneecap to track naturally on the Tibia.
Sports Massage techniques to the thigh, particularly outside of the thigh can assist in releasing the tight lateral structures. Foam roller exercises may also be beneficial.
Return to fitness and prevention
Return to full fitness should be gradual and sports specific training should only begin when there is no pain. Full strengthening exercises should have been done to restore the muscles to full and balanced strength.
It may be necessary to tape the knee or wear a support whilst returning to sport but do not get to rely on it long term unless specified by your therapist. Any biomechanical abnormalities (e.g. pronation) should be corrected to prevent the injury returning.