Patellofemoral pain

This APTA Orthopaedic academy guideline on patellofemoral pain was published in JOSPT in 2019 for physical therapists and other rehabilitation clinicians. It covers diagnosis, a proposed classification by main impairment, outcome and examination measures, and treatment.

It recommends diagnosing patellofemoral pain mainly by pain around or behind the kneecap that is reproduced by squatting and other loaded bent-knee activities, once other causes have been excluded. Its central treatment recommendation is exercise combining hip- and knee-targeted strengthening, which it treats as the core of any combined program.

Short-term options include prefabricated foot orthoses for people with greater than normal pronation, and patellar taping combined with exercise. It recommends against knee braces, dry needling, manual therapy (including lumbar or knee manipulation and mobilization) used on its own, and physical agents such as ultrasound and electrical stimulation. Blood flow restriction with high-repetition knee exercise is listed as an option for people who cannot tolerate resisted knee extension.