What is Patellofemoral pain syndrome?

Do you suffer from:

  • a sore knee when running
  • Increased pain after squatting movements and walking up and down stairs
  • Pain after sitting for a long time with your knees bent
  • The feeling of grinding or clicking sound in the kneecap when you bend and straighten your knee
  • Kneecap region that is tender to the touch?

You may have Runner’s Knee, AKA – Patellofemoral pain syndrome.

What is Patellofemoral pain syndrome?

Patellofemoral pain syndrome, commonly known as Runner’s Knee is one of the most common knee complaints seen by Fixio physios. Patellofemoral pain syndrome can be found in both the young active sportsperson and the elderly and if not treated properly, can hang around for years.

Patellofemoral pain syndrome is pain felt behind and around your kneecap, where your patella (kneecap) meets your thigh bone (femur). This joint is known as your patellofemoral joint.

What causes Patellofemoral pain and what are the symptoms?

In musculoskeletal physiotherapy, the most common reasons for runner’s knee are overuse, muscle performance deficits, and trauma. Patellofemoral pain is what’s known as a heterogenous condition, meaning that not everybody that suffers it will have the same symptoms.

The symptoms of runner’s knee are notorious for looking like other conditions and over the past few years there has been an influx of new treatment guidelines that has changed the way physiotherapists treat Patellofemoral pain. It is important to see a musculoskeletal physio who has plenty of clinical experience with the injury and is constantly updating their skills. These experts are best placed to make an accurate diagnosis so you can move onto the recovery phase.

If you have:

  • Sudden or severe pain in the knee
  • Heard a loud pop or snap during sport or exercise
  • Swelling in the knee after feeling pain
  • A feeling of looseness in the joint
  • An inability to put weight on the joint without pain, or any weight at all

These could all be symptoms of Patellofemoral pain syndrome.

 Figure 1 Schematic overview of potential pathways to elevated patellofemoral joint (PFJ) stress, a proposed contributor to patellofemoral pain.[1]

Do I need surgery?

Most likely no. People with patellofemoral pain syndrome alone do not need surgery. Be patient, and keep exercising to get better. Runner’s knee can be hard to treat. Some people get better quickly, but for others it might take six weeks or even longer for your knee to feel better.

How do musculoskeletal physiotherapists treat Runner’s Knee?

Thankfully, non-operative treatment provided by an expert physio is effective for most patients.[2] Each treatment program is designed specifically to combat the root cause of your patellofemoral pain.

Once we have identified the cause of your pain and any underlying functional improvements we can work on, your physio will be able to guide you through your bespoke program. Physiotherapy may include exercises to make your hip, core, and knee muscles stronger and more flexible. Squats, quadriceps exercises, leg raises, climbing, and leg presses can be good since they target these specific areas.

Common treatments for patellofemoral pain include:

  • Exercise therapy with hip and knee exercises
  • Short-term tailored patellar taping
  • Patient specific education in relation to biomechanics and exercise therapy
  • Advice on loading programs

Will the pain come back?

Patellofemoral pain syndrome can come back.

The simplest advice for keeping runner’s knee at bay includes trying not to overstress your knees and listening as closely as you can to your body. You can do this by:

  • Losing weight if needed
  • Warming up before running
  • Increasing your activities gradually
  • Wearing good running shoes

If your knees are painful, take a break from activities that cause a lot of pounding on your legs, like running, volleyball, or basketball.

Instead, try swimming or another low-impact activity. As your knees feel better, you can slowly go back to your normal sports.

Make an appointment to see us at Fixio Physio for more information of Patellofemoral pain syndrome and what can be done to overcome it.


[1] Powers CM, et al. Br J Sports Med 2017;0:1–11. doi:10.1136/bjsports-2017-098717

[2] Kannus P, Natri A, Paakkala T, et al: An outcome study of chronic patellofemoral pain syndrome. Seven-year follow-up of patients in a randomized, controlled trial. J Bone Joint Surg 81A: 355–363, 1999

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