Understanding Patellofemoral Pain

Graphic of women stretching with toddlers
Posted November 30, 2021
Alex Remedios
BKin(Hon), MPT, PT Resident
Feeling pain around or behind your kneecap? Difficulty with squatting or going down stairs?

These symptoms among others are consistent with Patellofemoral Pain Syndrome (PFPS), which is one of the most common musculoskeletal conditions involving the knee joint that we treat here at Elora Physiotherapy.

PFPS affects individuals of all ages pursuing various sports and activities with higher rates observed in the adolescent population. Statistically, females are 2x more likely to develop PFPS than males (1).

PFPS is defined as the experience of pain around or behind the patella (kneecap) that is worsened with weight-bearing positions on a bent knee in the absence of other more-specific pathologies (2). It is also referred to as chondromalacia patella and is often associated as one of the conditions under ‘runner’s knee’. It is a clinical diagnosis that presents with a set of specific symptoms that rarely requires imaging to both assess and treat.

Symptoms that individuals may report in the presence of PFPS are: (3, 4)

  • Pain with running or going down stairs
  • Pain that develops with prolonged sitting
  • Small effusion or swelling around the knee
  • Feeling of ‘giving way’ or ‘buckling’
  • Crepitus or grinding in the knee with certain weight-bearing movements

So, what causes PFPS?

A definitive cause for the pain associated with PFPS has not yet been determined in the literature and it remains unclear which structures are responsible for the pain experienced in the condition. Symptoms are likely driven by unaccustomed loading on the patellofemoral joint or changes to the mechanics due to a combination of risk factors (4).

These risk factors include: (5, 6).


  • Weakness in the hip/knee
  • Foot posture abnormalities
  • Decreased trunk and pelvic control
  • Altered patellar position, Muscular imbalances


  • A sudden increase in sport/activity
  • Changes in environmental conditions or playing surfaces

Due to the complexity and multifactorial nature of PFPS, a thorough physical examination of modifiable risk factors to determine an individualized clinical approach is key for management.

Your physiotherapist will be able to perform an in-depth evaluation to determine the influences of these factors along with potential psychological factors to form a plan of care in order to reach your movement goals.

Conservative management with physical therapy is widely considered as the primary mode of intervention to treat PFPS (3). Exercise therapy consisting of hip and knee strengthening, along with core and pelvic control have been shown to reduce pain and improve functional outcomes in patients (1, 4).

In combination with a tailored exercise program; physiotherapy treatment may also include: (2, 4, 5)

  • Education surrounding pain neuroscience, reducing fear of movement, and graduated return to sport
  • Manual therapy and soft tissue techniques
  • Patellar taping
  • Bracing and foot/ankle orthoses
  • Therapeutic modalities such as ice, heat, acupuncture/dry needling as indicated

As physiotherapists we have advanced training assessing movement and prescribing exercise and we are here to help you to return to and excel in the activities you love. If you are looking to learn more or feel that you could benefit from physiotherapy treatment feel free to book in for an assessment!



Rathleff, M. S., Vicenzino, B., Middelkoop, M., Graven-Nielsen, T., van Linschoten, R., Hölmich, P., & Thorborg, K. (2015). Patellofemoral pain in adolescence and adulthood: Same, same, but different?. Sports Medicine45(11), 1489-1495.

Hott, A., Brox, J. I., Pripp, A. H., Juel, N. G., & Liavaag, S. (2020). Patellofemoral pain: One year results of a randomized trial comparing hip exercise, knee exercise, or free activity.Scandinavian journal of medicine & science in sports, 30(4), 741-753.

Gaitonde, D. Y., Ericksen, A., & Robbins, R. C. (2019). Patellofemoral pain syndrome.American family physician, 99(2),88-94

Brukner, P. & Khan, K. (2016).Clinical Sports Medicine: Injuries (5th ed.).McGraw-Hill Education.

Willy, R. W., Hoglund, L. T., Barton, C. J., Bolgla, L. A., Scalzitti, D. A., Logerstedt, D. S., … & Torburn, L. (2019). Patellofemoral pain: clinical practice guidelines linked to the international classification of functioning, disability and health from the academy of orthopaedic physical therapy of the American physical therapy association. Journal of Orthopaedic & Sports Physical Therapy, 49(9), CPG1-CPG95

Halabchi, F., Abolhasani, M., Mirshahi, M., & Alizadeh, Z. (2017). Patellofemoral pain in athletes: Clinical perspectives.Open Access Journal of Sports Medicine, 8, 189–203. https://doi.org/10.2147/OAJSM.S127359