DIAGNOSIS EVALUATION AND CLASSIFICATION OF

PATELLOFEMORAL PAIN SYNDROME

By Erik Witvrouw PT, PhD

INTRODUCTION Patellofemoral pain syndrome (PFPS) is the most prevalent disorder involving the knee in adolescents and young adults. Research has shown an incidence as high as one in four, and even higher, among athletes (1). Anterior knee pain is usual- ly located in the retropatellar or peri- patellar regions and is described as a dull ache or throbbing feeling. The pain is aggravated by activities involving increased patellofemoral compression forces such as running, cycling, jumping, sitting with the knees bent, ascending or descending stairs, kneeling and squat- ting. Once started, the patellofemoral pain syndrome (PFPS) frequently becomes a chronic problem forcing the patient to stop sports and other similar activities.

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It is generally agreed that patellofemoral pain should be managed initially by con- servative rather than operative means. Conservative treatments for patellofemoral pain remain varied and controversial. Today, little consensus exists regarding the most appropriate conservative treatment. Open kinetic chain leg extension exercises have been the traditional means of strengthening the quadriceps. However, several authors report that these exercises exacerbate symptoms in many patello- femoral patients (2,3).

The clinical use of closed kinetic chain exercises has been increasingly discussed over the past few years. One of the rea- sons these exercises have received increased attention within the rehabilita- tion community is that they simulate and replicate many functional movements (4,5).

In addition to a physical therapy exercise programme, other modalities like non- steroidal anti-inflammatory drugs, rest regimes, or patellar braces are frequently used. The effectiveness of these treatment programmes varies. Previous literature states that treatment consisting of elimi- nation of symptom-producing activities, non-steroidal anti-inflammatory medica- tion, and intensive quadriceps muscle exercises is effective in more than half of the patients with the anterior knee pain although there is considerable individual variation in the treatment response. One important reason for finding this broad variation in treatment results is that today PFPS is still used to describe differ- ent entities. However in reality the grow- ing consensus is that PFPS comprises sev- eral different entities. Therefore, it seems imperative to thoroughly clinically exam- ine the PFPS patient, assign each patient

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