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Guidelines - Patellofemoral Pain
This tool provides information to facilitate the management of patellofemoral pain (PFP) in adolescents and adults.
Focused examination
1. Patient History
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Rule out risk factors for major structural or other pathologies. If required, refer to an appropriate healthcare provider.
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Identify and assess other conditions and co-morbidities. Manage using appropriate care pathways.
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Address prognostic factors that may delay recovery.
Major structural or other pathologies (red flags):
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Sharp pain, persistent nagging ache, unexplained deformity, swelling, or redness of the skin, weakness not due to pain, fever/chills/feeling ill, pain at rest
Examples of other conditions/co-morbidities:
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Physical conditions: back pain, headache
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Psychological conditions: depression, anxiety
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Co-morbidities: diabetes, heart disease
Examples of prognostic factors that may delay recovery:
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Symptoms of depression or anxiety, passive coping strategies, job dissatisfaction, high self-reported disability levels, disputed compensation claims, somatization
2. Physical Examination
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Rule out major structural or other pathologies.
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Assess for neurological signs.
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Appropriately diagnose PFP.
Criteria for PFP:
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Presence of retropatellar or peripatellar pain AND;
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Reproduction of retropatellar or peripatellar pain with squatting, stair climbing, prolonged sitting, or other functional activities loading the patellofemoral joint (PFJ) in a flexed position AND;
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Exclusion of all other conditions that may cause anterior knee pain including tibiofemoral pathologies
3. Management
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Offer information on nature, management, and the course of PFP. See patient handouts for more information to provide to patients.
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Discuss the range of effective interventions with the patient and, together, select a therapeutic intervention.
Patient Handouts
Therapeutic Management of PFP
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:
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Consider multimodal careᶧ
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Cobination of hip– and knee-targeted exercise therapy and one or more of the following:
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tailored patellar taping in combination with exercise therapy
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prefabricated foot orthoses for those with greater than normal pronation
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physical therapy
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gait retraining
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acupuncture
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Consider load management education, body weight management (when appropriate)
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Consider blood flow restriction plus high-repetition knee exercise therapy
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Do not offer dry needling
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Do not offer manual therapy including lumbar, knee, or patellofemoral manipulation/mobilization
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Do not offer patellofemoral knee orthoses, including braces, sleeves, or straps
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Do not offer EMG-based biofeedback on medial vastii activity to augment knee-targeted (quadriceps) exercise therapy
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Do not offer visual biofeedback on lower extremity alignment during hip- and knee-targeted exercises
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Do not offer biophysical agents, including ultrasound, cryotherapy, phonophoresis, iontophoresis, electrical stimulation, and therapeutic laser
*Interventions are recommended if guidelines used terms such as ‘recommended for consideration’ (e.g., ‘offer’, ‘consider’), ‘strongly recommended’, ‘recommended without any conditions required’, or ‘should be used’. Recommendations from low-quality evidence are not listed.
ᶧMultimodal care: treatment involving at least two distinct therapeutic modalities, provided by one or more health care disciplines.
Care Pathway for the management of patellofemoral pain
4. Reevaluation and Discharge
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Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered.
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Monitor for any emerging factors that may delay recovery.
5. Referrals and Collaboration
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Refer the patient to an appropriate healthcare provider for further evaluation at any time during their care if they develop worsening symptoms and new physical or psychological symptoms.