Patellofemoral Pain Syndrome


Patellofemoral pain syndrome (PFPS) is a condition characterized by pain in the front of the knee joint. The pain in and around the kneecap, known as patellar pain, occurs when the connection between the patella and femur becomes uncomfortable. This discomfort is caused by excessive pressure on the joint due to misalignment of the kneecap.

This can lead to irritation and deterioration of the joint surface behind the kneecap. Athletes who participate in activities such as running, jumping, landing sports, and squatting are particularly susceptible to this condition, often due to abnormal muscle balance or poor control of their movements. So diagnosis and treatment at an early time is important.

What Is the Reason Behind the Occurrence of Patellofemoral Pain Syndrome (PFPS)?

PFPS can occur due to several reasons:

  • Overuse: Activities that involve running or jumping or playing sports that involve running and jumping excessively can put repeated stress on the knee, leading to irritation under the kneecap. Knee pain that is aggravated due to repeated use can lead to PFPS.
  • Muscle Imbalances or Weaknesses: If the muscles such as vastus medialis around the hip and knee do not keep the kneecap properly aligned, patellofemoral pain can occur. For instance, moving the knee inward during a squat is linked to patellofemoral pain.
  • Injury: Trauma to the kneecap, such as dislocation or fracture, is most sometimes seen in patients with PFPS.
  • Post-Surgery: Knee surgeries, especially those involving the anterior cruciate ligament where the patellar tendon is used as a graft, can increase the risk of patellofemoral pain.

What biomechanical factors contribute to the development of Patellofemoral Pain Syndrome?

young man with knee pain due to overuse injury. Patellofemoral pain syndrome can be caused by overuse.
Photo Credit: wayhomestudio, Freepik

PFPS is often the result of various biomechanical factors that affect the joint in knee. These include weak gluteal muscles, improper foot posture, muscle imbalances, and tight lateral knee structures. Adolescents are particularly susceptible due to the faster growth of their long bones compared to their muscles, tendons, and ligaments.

This discrepancy can lead to abnormal joint stress, especially if they are physically active and do not stretch properly leading to pain around the knee. Furthermore, repeated trauma from poor biomechanics during walking or running can also cause this syndrome. Addressing these issues during rehabilitation is crucial to prevent future injuries.

The causes of PFPS include:

  • Weak Gluteal Muscles and Improper Foot Posture: These conditions can lead to abnormal twisting of the knee and a sideward deviation of the patella.
  • Muscle Imbalances: An imbalance between the inner and outer quadriceps muscles can cause the patella to veer sideways within its groove.
  • Tight Lateral Knee Structures: Structures such as the lateral retinaculum, VL, and ITB can cause the kneecap to move sideways.
  • Inadequate Control of Hip Muscles: This can result in muscle imbalances and the lateral displacement of the patella.
  • Faster Growth of Long Bones in Adolescents: This can result in abnormal joint stress, particularly if young individuals are physically active and fail to stretch their muscles properly.
  • Repeated Trauma from Poor Biomechanics: Ongoing damage caused by improper walking or running mechanics can also cause this syndrome.

What Are the Indications and Symptoms of Patellofemoral Pain Syndrome?

The indications of PFPS typically include a dull, aching pain where the knee joint meet. The pain can increase under certain conditions, such as:

  • Walking Up or Down Stairs: The action of bending the knee during these activities can exacerbate the pain.
  • Kneeling or Squatting: Pain during squatting and kneeling put additional pressure on the knee joint, leading to increased discomfort, sometimes confirming the diagnosis of PFPS.
  • Sitting for Long Periods: This position, often referred to as “theatre knee,” can cause pain due to the constant pressure on the knee joint. Sitting minutes at a time with knees bent can cause pain.

If the knee pain does not improve within a few days, or if knee mobility becomes more difficult, it is recommended to consult with a healthcare provider.

Treatment of Patellofemoral Pain Syndrome

PFPS is a prevalent knee ailment that results in discomfort of the knee around the patella.

knee exercise can help alleviate PFPS.
Photo Credit: Freepik

To address the condition, a mixture of exercises, physiotherapy, and changes in lifestyle are usually recommended. Various treatment options include exercise, physiotherapy, and lifestyle adjustments.

  1.  Exercise: Engaging in exercises that focus on strengthening the muscles surrounding the knee can positively impact reducing pain and enhancing the overall function of the patellofemoral joint. Specifically, targeting muscles such as the quadriceps, gluteal, and those in the foot arch can be especially advantageous. To tailor an exercise regimen suited to your specific needs, it is recommended to seek guidance from a physiotherapist.
  2.  Physiotherapy: A physiotherapist can collaboratively design a treatment strategy with you that incorporates workouts, stretching and strengthening exercises, primarily knee flexion, and manual therapy methods, all aimed at minimizing pain, enhancing overall functionality and bringing back range of motion to the affected knee. Sports physical therapy is recommended for athletes as tailored knee and hip exercises can help.
  3.  Rest and ice: Individuals with patellofemoral pain can use ice and rest to alleviate pain and reduce swelling during the initial stages of PFPS. It is one of the affordable ways of treating PFPS.
  4.  Footwear modifications: Wearing shoes that offer sufficient support and cushioning can assist in diminishing knee discomfort. Your physiotherapist or podiatrist can suggest suitable shoes for you.
  5.  Taping or bracing: Patellar taping or bracing the kneecap can offer extra assistance and help in pain reduction. Your physiotherapist can suggest a suitable taping for patellofemoral pain syndrome.
  6. Nonsteroidal anti-inflammatory drugs (NSAIDs) help reduce inflammation and pain in the body: Ibuprofen, an over-the-counter pain reliever, can lessen pain often for the pain.

Collaborating closely with your health care provider who has your past history and physical examination can help to create a customized treatment plan for your specific condition is crucial. By receiving appropriate treatment, individuals with PFPS can anticipate a notable enhancement in their symptoms.


What is Patellofemoral Pain Syndrome?

Patellofemoral Pain Syndrome is a condition that causes pain at the front of the knee, commonly known as runner’s knee, jumper’s knee, or anterior knee pain.

What are the symptoms of Patellofemoral Pain Syndrome?

The symptoms of PFPS include aching pain in the front of the knee, particularly around the kneecap due to overload of the patellofemoral joint. The pain or discomfort often increases with walking, running, jumping, and climbing stairs.

What are the causes of Patellofemoral Pain Syndrome?

PFPS can be caused by various factors, including overuse, misalignment of the patella (kneecap), tight or weak muscles around the knee, hip and knee imbalances, and excessive stress on the knees during physical activities.

What are the risk factors for developing Patellofemoral Pain Syndrome?

Some risk factors associated with PFPS include previous knee injury or surgery, improper footwear, flat feet or high arches, weak quadriceps muscles, and participating in activities that involve repetitive knee bending and stress.

How is Patellofemoral Pain Syndrome diagnosed?

The diagnosis of Patellofemoral Pain Syndrome usually involves a physical examination by a healthcare provider, such as a sports medicine specialist or a physical therapist. Imaging tests, such as X-rays or MRI, may also be used to rule out other knee problems.

What is the treatment for PFPS?

The treatment for PFPS typically includes a combination of conservative approaches and physical interventions. These may include rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), appropriate exercises to strengthen the muscles around the knee, and modifications to physical activities to reduce knee stress. In some cases, a knee brace or orthotics may be recommended.

Can physical therapy help in treating Patellofemoral Pain Syndrome?

Physical therapy is often a key component in treating Patellofemoral Pain Syndrome. A physical therapist can provide exercises and techniques to address muscle imbalances, improve knee alignment, and enhance overall knee strength and stability.

What should I expect during physical therapy for Patellofemoral Pain Syndrome?

During physical therapy for PFPS, you can expect a comprehensive evaluation of your knee and its surrounding structures. The therapist will develop a customized treatment plan that may include exercises to stretch tight muscles, strengthen weak muscles, improve flexibility, and enhance knee biomechanics.

Can Patellofemoral Pain Syndrome be prevented?

While preventing PFPS may not always be possible, some steps can help reduce the risk. These include maintaining strong and balanced muscles around the knee through exercise therapy, wearing appropriate footwear, using correct techniques during physical activities, and gradually increasing the intensity and duration of exercise to avoid overuse.

Are there any complications associated with Patellofemoral Pain Syndrome?

If left untreated or poorly managed, PFPS can lead to chronic pain and limitation in daily activities. It is important to seek professional medical advice and appropriate treatment to prevent long-term complications.