I was comparing notes with a friend who is on my volleyball team. We are both being treated for the same problem (patellofemoral pain syndrome). Her treatment seems to be completely different from mine. But we’re both getting better (we think). That doesn’t seem to make sense to us. Can you explain it?

Physical therapists often treat athletes with patellofemoral pain syndrome (PFPS), a common cause of knee pain when squatting, kneeling, running, and going up and down stairs. There isn’t one individual test that can confirm the diagnosis of PFPS. And there isn’t one best way to treat the problem either.

That puts therapists in a bit of a quandary when it comes to choosing the right way to treat patients with this problem. Many studies have been done to sort out what works best. Is it taping? Taping with exercise? Exercise alone? If exercise helps, what kind of exercise is advised?

It is believed that PFPS occurs because of altered biomechanics between the patella (knee cap) and the femur (thigh bone). The patellofemoral joint is where the kneecap moves up and down over the lower end of the femur. It makes sense that restoring normal patellofemoral biomechanics should reduce pain and improve function. But a one-size-fits-all type of treatment program has not been found.

Studies show that taping the knee to improve patellar tracking (movement up and down over the femur) can be helpful. But the proper (most effective) method of taping is still under investigation. Other studies have shown that strengthening the quadriceps muscle over the front of the thigh and/or hip muscles can alter the symptoms of PFPS. Exercising these muscles seems to improve proprioception (sense of joint position) in the leg. The result is decreased pain and improved function.

Yet another direction in treatment has been the use of manual therapy techniques for PFPS. In this approach, the therapist uses nonthrust or thrust manipulations of the hip, knee, and/or patella to relieve pain and improve movement. There is support that this method is successful.

Using multiple treatment techniques at the same time to affect the entire kinetic chain (foot to spine) may work for PFPS because it addresses the biomechanical links between the foot, ankle, knee, hip, pelvis, and spine.

The results of studies so far support the idea that PFPS occurs as a result of multiple interactions (dysfunctions) between these regions. Treating the lower extremity as a functional unit may respond no matter what combination of specific interventions are used.