Patellofemoral pain syndrome

Diagnosis

Your healthcare professional might ask about your history of knee issues and discuss what activities you do. Diagnosis also relies on a physical exam. During the exam, your healthcare professional may press on your knee, move your leg into a variety of positions, and watch how you walk, squat or climb stairs.

Sometimes imaging tests can help find the cause of knee pain. Tests might include:

• X-rays. X-ray images show bones well. X-rays aren't as good for viewing soft tissues.
• MRI. Using radio waves and a strong magnetic field, MRIs show detailed images of bones and soft tissues, such as the knee ligaments and cartilage. But MRI scans cost much more than X-rays, CT scans or ultrasounds.
• Ultrasound. This test uses soundwaves to show images of muscles and tendons.

Treatment

Treatment of patellofemoral pain often begins with simple measures. Rest the knee as much as possible. Try not to do things that increase the pain, such as climbing stairs repetitively, kneeling or squatting.

Medicines

If needed, take pain relievers you can get without a prescription. These include acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Don't take them for more than 2 to 3 weeks.

Therapy

A physical therapist might suggest:

• Rehabilitation exercises. Certain exercises strengthen the muscles that support the knees and keep the leg in line. Keeping the knee from moving inward while squatting is a main goal.
• Better movement training. Physical therapists now work on how you move, not just strength. This includes learning better landing and squatting techniques, adjusting running form, and improving balance and coordination.
• Supportive braces. Knee braces or arch supports may help reduce pain.
• Taping. Your physical therapist may show you how to tape your knee to reduce pain and make it easier to exercise.
• Icing. Icing your knee after exercise might help with pain and swelling.
• Orthotics. Custom-made or ready-made shoe inserts might help take stress off the knee.
• Knee-friendly sports. During recovery, it might help to stick to sports that are easier on the knees, such as bicycling or swimming.

Surgery and other procedures

If simple treatments don't relieve pain, your healthcare professional might suggest:

• Targeted injections. Corticosteroid injections may help give short-term relief for pain. Hyaluronic acid injections can help lubricate the joint and may help relieve pain for several months. Other injection types, including platelet-rich plasma, are still being studied and are used selectively for treatment of patellofemoral pain.
• Arthroscopy. During this procedure, a surgeon inserts a pencil-thin device into the knee through a tiny cut in the skin. This device, called an arthroscope, has a camera lens and light. Tools to repair the knee can be inserted through other small cuts in the skin.
• Realignment. In more-severe cases, a surgeon may need to operate on the knee to fix the angle of the kneecap or relieve pressure on the cartilage.

Preparing for your appointment

You might start by seeing your primary care team. Or you might be referred to a physical medicine and rehabilitation specialist, also known as a physiatrist, a physical therapist, an orthopedic surgeon or a sports medicine specialist.

Here's information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of the following:

• Your symptoms and when they began.
• Key personal information, including whether you've ever injured your knee or had knee surgery and what type of exercise or sports you take part in.
• All medicines, vitamins or supplements you take, including doses.
• Questions to ask your healthcare team.

Take a family member or friend along, if possible, to help you remember the information you're given. Also, if you've had X-rays or other imaging tests of your knees, try to bring copies of them to your appointment.

For patellofemoral pain syndrome, questions to ask your healthcare team include:

• What's likely causing my knee pain?
• What are other possible causes?
• What tests do I need?
• Is my condition likely temporary or long-lasting?
• What's the best course of action?
• Do I need to restrict my activities?
• Should I see a specialist?
• Are there brochures or other printed materials I can have? What websites do you recommend?

Ask any other questions you have.

What to expect from your doctor

Be prepared to answer questions, such as:

• How would you describe your knee pain?
• Where exactly does it hurt?
• What activities improve or worsen your symptoms?
• Have you recently started exercising or exercising more?
• What home treatments have you tried? Did they help?