Patellofemoral pain (PFP) is the most prevalent non-traumatic knee pain condition in adolescents, affecting 6-7 per cent of school-aged adolescents, with a higher prevalence among girls and adolescents participating in sport. PFP has a substantial impact on physical function, quality of life and social activities in adolescents and the pain can restrict their participation in sports and recreational activities, often reaching beyond physical limitations to influence social interactions and emotional well-being. Up to 40 per cent of adolescents with PFP report ongoing pain and functional limitations after five years.

PFP is defined as pain around or behind the patella, especially during load-bearing activities like running, squatting or climbing stairs. Pain can be local or more widespread, and long-standing duration is often associated with more widespread symptoms extending beyond the knee. Variable pain representation may represent the involvement of different underlying structures.

Each adolescent with PFP has a unique set of factors contributing to the onset and persistence of their knee pain, and it is important to identify potential contributing factors. Risk factors may include specialising in one sport versus participating in several sports or physical activities, cumulative load on the knee, load spikes, lack of physical activity and psychosocial factors. Research suggests that higher pain frequency, a lower health-related quality of life, being female and psychological factors including anxiety, depression and fear may increase the risk of a poorer prognosis, but this research is still under development.

In their Journal of Physiotherapy Invited Topical Review, Michael Skovdal Rathleff and Natalie Collins outline the current consensus for diagnosis and assessment of PFP in adolescents, and summarise current evidence for treatment and prevention strategies. Interventions discussed include education and self-management, exercise, psychologically-informed interventions to address activity-related fear, footwear and taping.

The authors also discuss the need for further research into effective interventions and approaches to optimise outcomes in adolescents with PFP, differentiating between management of recent-onset versus long-standing PFP, and paving the way for more targeted management. More research is also required to investigate the various factors involved in PFP and the development of prevention strategies to reduce the prevalence and severity of PFP in different adolescent populations.

For more information and to read the entire article, see Invited Topical Review.

This blog is a Physiotherapy Research Foundation (PRF) initiative.

Dr Michael Skovdal Rathleff is a physiotherapist and Professor at the Department of Health Science and Technology at Aalborg University and at the Center for General Practice at Aalborg University, where he is head of the Musculoskeletal Health and Implementation Research Group. His research is focused on improving musculoskeletal health across the lifespan.

Dr Natalie Collins is an APA Sports & Exercise Physiotherapist, and Associate Professor in Physiotherapy at The University of Queensland. Her research focuses on improving the lives of people with knee pain conditions across the lifespan.