Did you just return from a visit with your child’s (or your) primary care, orthopedic, or sports medicine physician with a fancy physical therapy prescription that says “Patellofemoral Pain”? Half way through that visit were you frantically trying to spell “patellofemoral” as in your head you were thinking “what the heck, I thought it was just knee pain on stairs!”?
First, don’t freak out. Patellofemoral pain or patellofemoral pain syndrome (PFPS) is just a fancy (and correct) term for a common type of pain in the front of your knees usually related to overuse. Your patella is your knee cap and your femur is the long bone on which your patella should glide nicely as you bend and straighten your knees… like when you go up and down stairs!
Second, don’t worry. This is one of the most common injuries we treat, especially when specializing in adolescent athletes. And some good news is that we can usually treat this easily by addressing the correct strength, flexibility, or body mechanics that may be contributing to your pain. However, that also means you/the patient have to be really good and consistent with everything your physical therapist teaches you. And this doesn’t just mean at physical therapy. Overuse injuries typically require continued maintenance through a strong home exercise program even upon discharge from physical therapy. This doesn’t necessarily mean you’ll have to do your exercises every single day forever, but your physical therapist should discharge you from PT with a sustainable home exercise program for you to do at least a few days a week. And even more importantly, you should UNDERSTAND your plan and how it will help you to prevent your injury or pain from recurring.
Often patellofemoral pain begins with activities like running, jumping, squatting, or stairs and worsens with increased volume of these activities. However, sometimes the pain can worsen to the point that you have pain with easier activities like simply walking or standing up from a chair. So, the first step is to adjust the volume of your training activities that cause your knees to hurt (typically running, jumping, squatting, lunging, etc). This will allow your tissues some time to calm down and allow you and your physical therapist a chance to evaluate your knee pain and create and appropriate plan of care. So, if you haven’t come in for your physical therapy evaluation yet this is a good place to start.
Though many different athletes may all get the same diagnosis of patellofemoral pain syndrome (PFPS), each case will likely be a little different. I like to explain this like a pie chart. Typically there are at least 3 pieces of the pie chart (contributing factors to your patellofemoral pain)…. For example: strength, flexibility, and lower extremity mechanics…. but each individual athlete’s “pieces of the pie” may be different sizes. So, its important to find a good physical therapist who listens to you, evaluates you thoroughly, considers your specific sport, and thinks critically to create an individualized plan just for you.
Once you have adjusted your activities to calm down your pain, had an in-depth evaluation with your physical therapist, and gotten the first round of your home exercises, it is time to put in some work. Think of this as your opportunity to make big improvements in those areas your physical therapist identified as most important for you. This will then help you to have a smoother return to your full training volume. We will always do our best to keep you participating your sport as much as we can during this time. However, just know that pushing through pain will likely make the overall process much slower. Sometimes it just takes a little brainstorming with your physical therapist to figure out how to decrease your overall volume of stressful activities on your knees while still allowing you to participate in the more important parts of your sport when able. However, if you are not open to that compromise it can result in slow or no progress which could then sideline you even longer. So, have an open mind, work hard, and listen to your PT! We want you back in the game too!
Sometimes I think it helps to think of overuse injuries not as “injuries” at all. Just think of it as something you have to take a little better care of than someone else might. Everyone has something they have to work on and this might just be yours! Overuse injuries rarely ever just “go away”. They require you to work really hard to get them under control, then continue to take care of them so you can perform the volume of activities and sports that make you happy.
So, this brings me to the final step…. Fully returning to your sport and staying better. You’ve calmed down your pain, gotten strong, flexible, and/or improved your squatting, jumping, or running mechanics, and have a thorough and sustainable home exercise program. You’ve (hopefully) still been able to do some or all parts of your sport, but now its time to ramp back up to the volume you’d really like to be able to do for your training. This can be a moment when its easy to start being too busy for physical therapy or for your home exercise program, but then it can also be a moment when your pain returns. So, it is important to establish an organized return to sport program with your physical therapist and stick to it. It can sometimes be a little slower than you imagined, but just keep your eye on the big picture. A steady return to your full training accompanied by consistent performance of your strength and flexibility program is key. And once you are back in the swing of everything, don’t let yourself fall off the home exercise wagon. We hear too often of athletes who stopped doing their exercises consistently, then their pain/injury came back. We want you to leave our doors with the long term tools, knowledge, and confidence to stay healthy in the sport you love. But, don’t worry, we know things happen and we are ALWAYS here for you.
So, if you have that prescription in your hands (or if you don’t and these symptoms just sound familiar to you), take a deep breath of relief, give us a call, and know that we’ve got your back (and knees!).
Kate Hamilton, PT, DPT
Orthopedic Clinical Specialist