Understanding and Treating Patellofemoral Pain Syndrome Effectively | Blog Banner

Treating Patellofemoral Pain Syndrome Effectively

Patellofemoral pain syndrome, a prevalent knee concern, demands attention. Delve into its origins, symptoms, and treatments. Ensure your knee's longevity and deter further complications.

Dealing with knee pain can be challenging, and patellofemoral pain stands out among the various types of knee problems. Commonly referred to as the “runner’s knee,” athletes and non-athletes often encounter this anterior knee pain.

If you’ve ever felt an aching pain when climbing stairs or after prolonged sitting with knees bent, you might be familiar with patellofemoral pain syndrome (PFPS). Physical therapy, specifically hip and knee exercises, can be crucial in treating patellofemoral pain syndrome.

But what causes this pain in the patellofemoral joint, and how does it relate to conditions like chondromalacia patella or patellar tendon issues?

In this post, we delve deep into the causes, symptoms, and treatments, emphasizing the importance of a thorough physical examination, understanding the knee joint’s anatomy, and the benefits of exercise therapy.

Whether you’re a young adult experiencing this pain in one or both knees or looking for pain relief solutions like patellar taping or hip exercises, this guide has you covered.

Patellofemoral Pain Syndrome (PFPS) is a type of discomfort rooted in the patellofemoral joint and the tissues around it. It’s a persistent issue that often flares up during activities like squatting, prolonged sitting, stair-climbing, or running. While many used to call it “anterior knee pain”, it’s a bit of a misnomer.

PFPS pain isn’t just at the front of the knee; it can be felt all around, even at the back in the popliteal fossa. Some people see the symptoms slowly creep up on them, while others feel it more abruptly.

What’s more, it has a knack for returning; about 40% find the pain returning after a couple of years.

man holding his knee

Anatomy of the Knee Joint

The knee stands out as the body’s largest joint and is undeniably among its most intricate. The conjunction of the femur’s lower extremity, the tibia’s upper segment, and the patella (kneecap) form the knee. Ligaments and tendons reinforce these bones, ensuring stability.

Particularly significant is the patellar tendon, which extends from the patella to the tibia, facilitating knee movement.

As you flex and extend your knee, the patella glides seamlessly within the trochlear groove of the femur. This movement owes its fluidity to articular cartilage, reducing friction between bone surfaces. Enhancing this is the synovium, which produces a lubricant for the cartilage.

Additionally, a small fat pad beneath the kneecap cushions absorbs shock.

runner stopping and holding his knee

Causes and Risk Factors

Several factors can lead to PFPS. Overuse is a primary culprit, especially when there’s repeated stress on the knee, like during rigorous physical therapy sessions or specific hip and knee exercises. Conditions like patellar tendon issues or a patellar fracture can also play a role in the manifestation of PFPS.

 Repeated stress on the knee, such as during rigorous physical therapy sessions, specific hip and knee exercises, or strenuous activities highlighted in journals like Med Sci Sports Exerc and Br J Sports Med, can lead to PFPS. Overuse injuries often manifest in athletes and individuals undergoing intensive physical training.

 Imbalances in the hip muscles, like the hip abductors, and knee muscles can predispose individuals to PFPS. Tight muscles, notably the quadriceps tendon or hamstrings, can also contribute. Such imbalances might lead to altered hip kinematics, which places undue stress on the lower leg, particularly where the patella meets the thigh bone.

Improper training techniques, sudden shifts in physical activity intensity, or even equipment changes can act as a trigger. PFPS is sometimes referred to as “runner’s knee” or “jumper’s knee” due to its prevalence among these athletic communities.

Abnormalities like patella alta or issues with the lateral retinaculum can result in abnormal patellar tracking. Such structural deviations can cause referred pain from nerve endings in the region, further contributing to the chronic pain experienced.

A body mass index indicating overweight or obesity can intensify the pressure on the knees. Losing weight and achieving a healthy weight is often a recommendation by orthopedic surgeons and physical therapists to reduce pain. Several studies in Bone Joint Surg have highlighted the link between obesity and the risk of conditions like patellofemoral osteoarthritis.

Patellar tendon complications or even a patellar fracture can play a significant role in PFPS. PFPS’s also associated with the onset of conditions like patellofemoral osteoarthritis.

In some cases, PFPS may be associated with inflammation that can be alleviated with nonsteroidal anti-inflammatory drugs (NSAIDs). It’s essential, however, to consult with healthcare professionals before starting any medication.

For accurate diagnosis and targeted interventions, a comprehensive physical exam is paramount. Tools like magnetic resonance imaging (MRI) aid in differential diagnosis, distinguishing PFPS from other potential conditions.

Physical therapists may introduce specific exercises to strengthen the surrounding muscles, recommend relative rest, or use cold packs to provide temporary relief.

Patient-reported outcome measures can further help assess the patient’s progress and reduce pain.

Recognizing the Symptoms of Patellofemoral Pain Syndrome (PFPS)

The unmistakable symptom of patellofemoral pain is a lingering aching at the front of the knee. This discomfort can be experienced in one or both knees, making it vital to understand whether it affects a single knee or both knees. The common symptoms associated with PFPS are:

  • A notable pain during physical activities that involve knee extension, like running, squatting, or the simple act of climbing stairs. Such activities, especially with a flexed knee, often exacerbate the pain.

  • An onset of discomfort after prolonged sitting with the knees bent, a sensation familiar to those who might have spent hours in a movie theater or on a long-haul flight.

  • Fluctuations in pain intensity due to modifications in physical activity, equipment, or even the type of sports med gear used. Even the playing surface or changes in footwear can amplify this anterior knee pain encountered by many.

  • Audible sounds from the knee joint, such as popping or crackling, especially after sitting for an extended duration or during specific knee movements.

It’s also worth noting that physical interventions like patellar taping or using an elastic bandage might provide some individuals with temporary pain relief. In some severe cases, the affected knee might exhibit signs of inflammation.

man sitting in a couch holding his knee


A physical examination typically involves discussing symptoms and health history. A doctor will assess the pain’s location, possibly asking the patient to perform specific actions, like squatting. The physical exam might also include examining the following:

  • Alignment and position of the kneecap.

  • Knee stability, hip rotation, and motion range.

  • Signs of tenderness around the kneecap.

  • Strength and flexibility of surrounding muscles.

While often diagnosable through a physical exam, imaging like X-rays or magnetic resonance imaging (MRI) can offer additional insights.


treating knee pain

Treating Patellofemoral Pain Syndrome

Treating patellofemoral pain primarily revolves around nonsurgical interventions:

  1. Activity Changes: Reduce or modify activities that exacerbate knee pain.

  2. RICE Method: Rest, Ice, Compression, and Elevation can provide pain relief.

  3. Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) can alleviate pain and swelling.

  4. Physical Therapy: Incorporating specific hip and knee exercises can improve motion range, strength, and endurance. Exercise therapy, especially focused on the quadriceps and hamstrings, is essential.

  5. Orthotics: Shoe inserts can stabilize the foot and ankle, reducing knee stress.

In rare severe cases, surgical treatment like arthroscopy, debridement, lateral release, or tibial tubercle transfer might be considered.

treating the knee

Bottom Line

Patellofemoral pain, often called runner’s knee, predominantly affects young adults, especially those involved in athletic activities. It’s no wonder that pain reduction becomes a top priority for them.

Tight hamstrings can exacerbate this condition, but fortunately, with the right guidance, pain can be managed effectively.

Physical therapists and orthopedic surgeons alike recommend strengthening exercises as a go-to strategy for reducing pain.

Remember, the journey to becoming pain-free is a collaborative effort; with consistent effort and expert advice, one can treat patellofemoral pain and maintain a healthy, active lifestyle.


Treating patellofemoral pain syndrome (PFPS) often involves a combination of physical therapy, knee exercises, and hip exercises. A physical therapist will guide patients through specific exercises to strengthen knee and hip muscles, which can help address muscular imbalances. Interventions like patellar taping or an elastic bandage can also offer pain relief.

Patellofemoral pain, commonly referred to as a runner’s knee, arises from problems with the patellofemoral joint, where the patella (kneecap) meets the thigh bone. This anterior knee pain may result from tight muscles, imbalances in hip abductors or muscular imbalances, and the alignment of the knee joint. Other risk factors include excessive physical activity, prolonged sitting with knees bent, and climbing stairs.

Yes, most individuals can reduce or even become pain-free with the right interventions. Physical therapy, exercise therapy, and sometimes nonsteroidal anti-inflammatory drugs play a significant role. Maintaining a healthy weight is essential, as losing weight can reduce the strain on the knee joint. Moreover, specific exercises, such as strengthening exercises for tight hamstrings, can be beneficial.

People describe PFPS as an aching pain in the front of the knee, especially when the knee is flexed. This discomfort might intensify during activities like climbing stairs or after prolonged sitting with the knee bent. Typical symptoms might include a feeling of the knee giving way or the sensation of the knee “catching.”

While patellofemoral pain syndrome can cause significant discomfort, it’s not typically severe. However, if left untreated, it can lead to chronic pain or progress to conditions like patellofemoral osteoarthritis.

The duration varies for each individual. With proper physical interventions, such as physical therapy and specific exercises for the affected knee, many people experience pain relief within weeks. However, continuing the recommended exercises and maintaining physical activity levels are essential to prevent a recurrence.

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