Saturday, October 23, 2010

Why Patellofemoral Pain Syndrome Is Poorly Understood

I came across this on the Internet the other day -- the observation that patellofemoral pain syndrome (henceforth "PFPS" -- usually I hate acronyms, but I don't want to wear out my fingers typing that grandiose-sounding name again and again) is poorly understood -- and I thought I'd take a whack again at one of my favorite pinatas: the PFPS "diagnosis."

First, I don't argue with the statement that the condition is poorly understood. Just consider this observation from a July 2006 article in the New Zealand Journal of Physiotherapy Association: "Despite its prevalence, there is no clear consensus in the literature regarding terminology, the aetiology or treatment for PFPS."

So why is medical science baffled by PFPS so much? The kneecap almost sounds like the body's Bermuda Triangle, where a normal disease process goes and gets lost and becomes God knows what.

Here's my theory: PFPS is poorly understood partly for the same reason leg pain syndrome is poorly understood.

For those unfamiliar with leg pain syndrome (LPS), it's a collection of symptoms that describes certain aches and pains in the leg. They can appear in the arch of the foot, the back of the heel, the knee, the hip, the front of the leg -- in a number of places, really. The pain is often brought on by exercise or rapid movements of the limb.

The condition is poorly understood and hard to treat. What works for one case of LPS may not work for another. For instance, one sufferer of LPS may have a tear in the muscle in the arch of his foot, while another may be suffering from a sore tendon in the front of his knee. The two, of course, need different treatment modalities, making it difficult to devise standard practices for handling cases of LPS.

If you haven't figured it out by now, the last two paragraphs are bullcrap. There is no such thing as LPS.

It's just an exaggeration of what PFPS is: an overly broad and not-too-useful diagnosis that ends up confusing the patient. Because, to start with, PFPS simply means "knee pain." Actually, to be fair: "pain around the kneecaps with certain characteristics."

But what's missing here? The same thing that makes the LPS diagnosis pretty worthless: any kind of explanation as to what's causing the knee pain. What use is a diagnosis that regurgitates the symptom cluster, then folds up its tent and goes home, finished?

What if you had a high temperature and visited a doctor who pronounced your problem as, "feverish head syndrome," or FHS. Pretty soon, as cases of FHS became widespread, you'd be reading sentences like, "Despite its prevalence, there is no clear consensus in the literature regarding terminology, the aetiology or treatment for FHS."

Because FHS isn't really a diagnosis (American Heritage dictionary: "the act or process of determining the nature and cause of a disease or injury).

Neither is PFPS.


  1. the major problem in medicine is that it is (or has become) "epidemiological" in nature.. invent a taxonomy and try to make statistics, and then pretend it is science, using correlations and ignoring causalities.. the causes of problems in the knee can be easily grouped on much more scientific terms.. i.e. bio-mechanical (i.e. x legs), trauma, biochemical, age.. etc..

    For instance, I did an MRI recently on my knee and an attending radiologist was giving me some crap about how some people have worse knees than others etc.. while it is obvious for me that my knee problems are caused primarily by trauma, perhaps exacerbated by some bad nutrition and lack of movement at times.. The knee with 2 osteophytes (one rather large) had surgery 10 years ago (partial meniscectomy), and some trauma in the years following. On the other leg I can do a one legged squat! I have no joint problems whatsoever in general, and the woman treated me as if I was some rheumatic 70 year old woman.. (I am a 35 year old male). And it is clear for me that my current problems are a direct result of mechanical interference by the before mentioned osteophyte(s) (one is large, the other insignificant)..

    Upon browsing literature on osteophyte excision, hoping to see if it can be done, whats the prognosis, whether they would grow back, etc. I find epidemiological CRAP questionnaire like "studies" (not to mention "meta analysis"). XX% had pain relieved, x% no, with an fin placebo group!!! Clearly, nowhere was it mentioned what history these people had, or the whereabouts of the excised osteophytes (mine are femoral, towards patella, mainly aggravating the soft tissues). I have NO degeneration in the femur-tibial joint, or of the patellar cartilage.. ligaments and tendons are fine, and the osteophytes actually have cartilage on them!

    I am astounded that real doctors, who operate on people, subscribe to that kind of BS..

    perhaps, in 50 years, they find treatment, if idiocracy does not progress further.. and they want to cure cancer like that too..

    1. Yes, a large-enough bone spur will definitely cause issues with your knees. I'm surprised that you were told some people just have worse knees than others, because that doesn't seem to be your case, or you'd have two bad knees, not one. And yes, a curious thing: bone spurs do grow cartilage! This is common. So it turns out that bone spurs, though unwelcome, are doing their best to "fit in" in the knee joint. Your body is always adapting!