Patellofemoral Pain Syndrome (PFPS)
What is Patellofemoral Pain Syndrome?
Patellofemoral pain syndrome (PFPS) is a condition that causes discomfort at the front of the knee, around the kneecap (patella), without any evident damage or structural issues in the knee joint. It is also commonly referred to as anterior knee pain or runner’s knee.
The patella, or kneecap, is embedded within the quadriceps tendon. This tendon connects the powerful quadriceps muscles in the thigh to the top of the shin bone (tibia). The underside of the patella is covered with smooth cartilage, allowing it to move effortlessly over the lower part of the thigh bone (femur) when the knee is extended or bent.
Patellofemoral pain is a broad term describing discomfort at the front of the knee, but specific conditions may also contribute to this pain, including:
- Chondromalacia patellae.
- Prepatellar bursitis (Housemaid’s knee).
- Osgood-Schlatter disease.
Other possible causes of knee pain include:
- Ligament sprains
- Meniscal (cartilage) injuries
- Osteoarthritis
- Rheumatoid arthritis
- Gout
- Septic arthritis
- Hip-related issues affecting knee function
Symptoms of Patellofemoral Pain Syndrome
Symptoms of Patellofemoral Pain Syndrome include:
- Pain around or behind the kneecap, often felt vaguely at the front of the knee.
- Symptoms that come and go over time.
- Both knees may be affected, though one is often worse than the other.
- Increased pain when walking upstairs, and particularly when descending.
- Aggravation of pain during activities like running (especially downhill), squatting, and certain sports that put pressure on the patella.
- Discomfort after prolonged sitting, such as after a long drive or watching a movie, which worsens when movement resumes.
- A grinding or clicking sensation (crepitus) when bending and straightening the knee.
- Possible mild swelling or puffiness around the kneecap.
- Normal range of motion in most cases.
Causes of Patellofemoral Pain Syndrome
Patellofemoral Pain Syndrome is likely due to a combination of factors that increase pressure between the patella and the lower femur. Common contributors include:
- Overuse, particularly in high-impact sports or increased training periods.
- Incorrect cycling posture, such as a saddle set too low or too far forward.
- Patellar maltracking, where the kneecap moves improperly over the femur, often due to muscle imbalances around the knee and hip.
- Weak hip muscles, which may cause the thigh bone to rotate inward, pulling the patella out of alignment.
- Foot posture issues, such as flat feet, which can lead to excessive inward rolling (pronation) and knee compensation.
- Repeated minor injuries or hypermobility of joints.
- Excess body weight and improper footwear.
A combination of alignment issues and overuse in sports is thought to be a leading cause of PFPS.
Diagnosis of Patellofemoral Pain Syndrome
Patellofemoral Pain Syndrome PFPS is typically diagnosed based on symptoms, medical history, and a physical examination of the knee. Imaging tests like X-rays or MRI scans are usually not necessary unless other conditions or patellar maltracking need to be ruled out.
Treatment for Patellofemoral Pain Syndrome
Short-Term Treatment:
- Reducing strenuous activity until the pain subsides while maintaining general fitness with low-impact exercises.
- Pain relief with medications such as paracetamol or anti-inflammatory drugs like ibuprofen.
- Physiotherapy to strengthen muscles around the knee and hip, helping to reduce stress on the knee joint.
- Specific exercises to correct alignment and muscle imbalances.
- Taping techniques to support the patella and potentially reduce discomfort, though long-term benefits are uncertain.
Long-Term Treatment:
- Addressing underlying causes, such as improving muscle strength and correcting foot posture.
- A long-term physiotherapy program, often lasting a year or more, focused on strengthening hip and thigh muscles.
- Wearing appropriate footwear, including arch supports for flat feet or well-cushioned running shoes.
- Weight management to reduce strain on the knees.
Surgical intervention is generally not recommended as a primary treatment for PFPS, as research indicates that most individuals achieve better outcomes with conservative (non-surgical) management. Surgery may be considered in rare cases where symptoms persist despite extensive conservative treatment.
Outlook for Patellofemoral Pain Syndrome
It was previously believed that most individuals would recover within 4-6 months with physiotherapy and other conservative treatments. However, recent studies suggest that over half of individuals with PFPS continue to experience pain and functional limitations even 5-8 years after treatment. Ongoing research is exploring new approaches to improve long-term outcomes for people affected by this condition.
Further information
Last updated07 Aug 2025