Patellofemoral Pain Syndrome and Modifiable Intrinsic Risk Factors; How to Assess and Address?

Abstract

Patellofemoral pain syndrome (PFPS) is a very common disorder of the knee. Due to multiple forces influencing the patellofemoral joint, clinical management of this ailment is particularly intricate. Patellofemoral pain syndrome has a multifactorial nature and multiple parameters have been proposed as potential risk factors, classified as intrinsic or extrinsic. Some of the intrinsic risk factors are modifiable and may be approached in treatment. A number of modifiable risk factors have been suggested, including quadriceps weakness, tightness of hamstring, iliopsoas and gastrosoleus muscles, hip muscles dysfunction, foot overpronation, tightness of iliotibial band, generalised joint laxity, limb length discrepancy, patellar malalignment and hypermobility. In general, the routine approach of physicians to this problem does not include assessment and modification of these risk factors and therefore, it may negatively affect the management outcomes. Changing this approach necessitates an easy and practical protocol for assessment of modifiable risk factors and effective and feasible measures to address them. In this review, we aimed to introduce assessment and intervention packages appropriate for this purpose.

Effectiveness of Manual Therapy Combined With Physical Therapy in Treatment of Patellofemoral Pain Syndrome: Systematic Review

“…1,11 Patellofemoral pain syndrome can also be related to genu recurvatum, 1 valgus knee, 1 lateral tibial torsion, 1 quadriceps weakness, 11,14 and other dysfunctions. 11,14 Most authors agree that in the absence of direct trauma, the etiology of pain in PFPS is multifactorial and involves a combination of intrinsic and extrinsic factors. Extrinsic factors include the type of activity, the practice of aggressive and repetitive sport or change in the intensity of a physical activity.…”

“…Also irregularities in sports activity, environmental conditions, or the surface and equipment used can be considered extrinsic factors. 1,11 Intrinsic risk factors are related, on one hand, to individual characteristics, such as malalignment of the lower limb or the joint or abnormal stresses on the patella and, on the other hand, to psychological factors, such as high levels of anxiety and fear-avoidance beliefs. 1,7,8,11 Patellofemoral pain syndrome is characterized by an unclear retropatellar or anterior pain in absence of other disorders.…”

“…1 Patellofemoral pain syndrome is usually caused by imbalances of the forces that control patellar movement during knee flexion and extension, in particular when overloading the joint. 8 Furthermore, there are various physical characteristics related to the development of PFPS, such as femoral anteversion, 1 internal rotation of the femur, 1 patellar malalignment, 1,11 or patellar hypermobility. 1,11 Patellofemoral pain syndrome can also be related to genu recurvatum, 1 valgus knee, 1 lateral tibial torsion, 1 quadriceps weakness, 11,14 and other dysfunctions.…”

“…8 Furthermore, there are various physical characteristics related to the development of PFPS, such as femoral anteversion, 1 internal rotation of the femur, 1 patellar malalignment, 1,11 or patellar hypermobility. 1,11 Patellofemoral pain syndrome can also be related to genu recurvatum, 1 valgus knee, 1 lateral tibial torsion, 1 quadriceps weakness, 11,14 and other dysfunctions. 11,14 Most authors agree that in the absence of direct trauma, the etiology of pain in PFPS is multifactorial and involves a combination of intrinsic and extrinsic factors.…”

“…1 It has a higher incidence in women than in men, 2 especially between 15 and 30 years old, [3][4][5][6][7] and it represents 25% to 40% of all treated disorders in sports medicine. [8][9][10][11][12][13] Patellofemoral pain syndrome often is referred to as patellofemoral chondritis, chondropathy, chondromalacia, anterior knee pain, patellar subluxation, patellar dislocation, or external overpressure syndrome. However, Patellofemoral pain syndrome is different from the patellar chondromalacia.…”