Patellofemoral Pain Syndrome (PPS)

80% of patients respond to conservative management.

Reduce activities that may have led to onset of symptoms, such as resistance training (lunges or full squats), increased mileage with running, or plyometric exercises.

Encourage relative rest using alternate exercises (ie, pool running, bicycling, swimming, or using an elliptical trainer).

Evaluate footwear with focus on excessive deterioration, inadequate support, or excessive support.

Ice application after activity can help with pain symptoms, but will not treat any underlying cause of the pain.

Strength training consists of closed chain (end of limb is in contact with a surface) or open chain (limb end is not in contact). Typical muscle strength deficits will be in the quadriceps muscle group, but can also be in the gluteus medius or core muscle groups.

Witvrouw et al. evaluated the long-term effects of an open vs a closed kinetic chain training program and concluded that both training programs lead to good functional outcome. On initial evaluation and 3 mos later, the closed chain exercises produced less pain, better functional improvement, and less subjective clicking. At the 5-yr follow-up, however, 3 of 18 evaluations by visual analog scales revealed the open chain group showed fewer complaints than the closed group (2).

Flexibility training should address the hamstrings, quadriceps, hip flexors, iliotibial band, and gastrocsoleus.

Hazneci et al. determined that isokinetic exercise (variable resistance applied so movement remains at a constant speed) has positive effects on knee joint position sense, which in turn increases strength and work capacity (3).