Education

Education is considered a vital component in the treatment of patellofemoral pain by experts, despite an absence of research directly evaluating its efficacy. Education targets should include managing patient expectations, load management, weight management when appropriate, ensuring self-management, teaching the importance of adherence to exercise-therapy, and implementing strategies to address fear of movement.

In this section, you will find some guidance to educate patients with patellofemoral pain.

Exercise and physical activity is very good for patient’s health and well-being. However, doing ‘too much, too soon’ may be a key reason they develop or continue to have patellofemoral pain?

If they are not sensible with how much exercise they do, other normally effective treatments may not actually end up helping their pain management. That’s why managing load is very important.

Take a look at the short video below to get some tips on how you can manage exercise and physical activity loads.

 

Why do patients need to be sensible with how much exercise they do?

The exact reason why patients develop patellofemoral pain is unclear. However, experts around the world tend agree that doing ‘too much, too soon’ in relation to exercise may be a key reason.

There seems to be a spike in the number of patients with patellofemoral pain following rapid increases to how much exercise they do – e.g. ‘start to run’ programs (e.g. couch to 5KTM).

The number of people developing patellofemoral pain when completing basic military training has been reported to be as high as 32%.

In ‘start to run’ programs it can be as high as 17%.

There are no specific rules on how much exercise patients should complete in order to avoid developing patellofemoral pain. It is also not clear exactly how quickly to increase exercise when returning to sports and other activities if patients are recovering from patellofemoral pain.

The most sensible option is to monitor pain levels during and after exercise. Experts frequently recommend that if patients have a large increase in pain, or pain stays increased for more than 24 hours after exercise, they may be doing ‘too much, too soon’.

 

Load management education to modify patellofemoral joint loading may include appropriate activity modification, movement pattern modification and training and exercise therapy to increase the capacity to handle exposure to load. Technologies, including smart phone applications and activity measuring ‘wearables’, provide an easily utilised objective method to analyse baseline levels of activity and determine the magnitude of change following specific interventions. A good summary of such devices can be found in an article published in the scientific journal Physical Therapy in Sport.

Fear of movement may exist in patients with patellofemoral pain. However, the most recommended intervention for patellofemoral pain is exercise, passive treatments are not likely to help.

 

Despite being quite common for patients with patellofemoral pain to be fearful of some movements (e.g. running, jumping and walking on stairs). Some studies report that reductions in fear of movement are related with reductions in the level of knee pain. Therefore, it is highly recommended for patients to keep doing all daily activities alongside the exercise program.

 

If they are not so confident to walking on stairs at the moment, you may find the following infographic helpful for educate patients.

 

 

 

Knee crepitus or noisy knee is a common complain/concern of patients with patellofemoral pain. We don’t know what causes the noise on the knees. But, recent data show that patients with patellofemoral pain who have noisy knees have similar levels of pain, function, fear of movement and knee strength compared to those who don’t have noisy knees. In other words, if a patient has patellofemoral pain and a noisy knee, it doesn’t mean his/her condition is worse than those who have patellofemoral pain and no noisy knee.

Additionally, a previous study investigated 250 asymptomatic knees (knees with no pain) and found that 99% of people had knee crepitus.

The previous published education leaflet titled ‘Managing My Patellofemoral Pain’  is a strong education tool and provide a great visualisation to guide patients on returning to exercise. See below the leaflet accompanying by translations into several languages (Spanish, Danish, Sweden, Portuguese, Italian)

 

Listen to Dr Michael Rathleff discuss about the importance of education for patients with patellofemoral pain: