Patellofemoral Pain Syndrome

PFPS is a condition that causes pain in and around the knee. Patellofemoral means kneecap (patella) and thigh bone (femur). This describes the area where the pain is located. 

Usually, the patella fits into a groove in your femur. It should slide smoothly along that space when you move your knee. If you have PFPS, the patella doesn’t move or track properly within the groove of the femur.

PFPS doesn’t only affect runners. It can affect anyone who participates in activities that require repetitive knee movement. 

What causes patellofemoral pain syndrome?

PFPS is caused by an imbalance of forces over your kneecap. Several factors can lead to this misalignment, including:

• Overuse: Activities like running, jumping, squatting or climbing stairs.  
• Muscle imbalance: Weak glutes, tight hip flexors, calf tightness, or weak quadriceps.
• Biomechanical problems: Flat feet or improper footwear.
• Injury: A direct hit to the knee or sudden increase in physical activity.

Who is at risk for patellofemoral pain syndrome?

Anyone can develop PFPS. However, some people are more likely to experience it, including:

• Athletes or physically active people who run, jump or squat a lot 
• Females 
• Adolescents and young adults
• People with osteoarthritis 

The primary symptom of PFPS is dull, aching pain around the front of the knee, particularly:

• When walking up or down stairs
• After sitting for a long time with knees bent
• When kneeling or squatting
• After long periods of physical activity

Some people hear or feel a rubbing, grinding or clicking sound of the kneecap when they bend or straighten their knee. The kneecap may also be tender to touch.

Your health care provider can diagnose PFPS by looking at your medical history and doing a physical exam. They will look at knee alignment, range of motion, strength and stability. They may also ask you to squat, jump or put pressure on the patellofemoral joint. 

If needed, your provider may order other imaging tests, like an X-ray, magnetic resonance imaging (MRI) or ultrasound.

Once diagnosed, PFPS is usually treated with conservative care (non-surgical treatments). This may include:

• Rest and activity modification: Avoid activities that cause increased pain and allow time for healing. 
• Ice and cold packs: Place ice packs on the knee every 1-2 hours for 15 minutes at a time. Put a thin towel between the ice and your skin to protect it from the cold. 
• Physical therapy: Working with a physical therapist can help reduce pain, strengthen the quadriceps and patellar tendon, improve knee function and prevent future issues with PFPS.
• Knee bracing: Knee braces and taping techniques, such as patellar taping, can help correct some issues.
• Pain management: Over-the-counter medicines like nonsteroidal anti-inflammatory drugs (NSAIDs) can help with pain and reduce inflammation. Make sure to take the recommended dose.

In rare cases, a knee arthroscopy may be recommended for younger patients without signs of significant arthritic components. This type of surgery is minimally invasive, with a few small cuts (incisions) in the skin around the knee. It is typically considered only when several months of conservative treatment fails to relieve pain and improve function. Knee arthroscopy may also be needed if you have cartilage damage or misalignment of the kneecap. 

Most people recover from PFPS within a month or two. Your health care provider and physical therapist will give you a timeline based on your needs, strength and activity level. You may have to change or take a break from usual activities until you no longer feel pain or other symptoms.

To prevent PFPS, here are a few tips to keep your knees healthy:

• Maintain a healthy body weight.
• Stretch, warm up and cool down to keep muscles flexible and balanced.
• Wear supportive shoes that fit well.
• Regularly exercise to strengthen leg muscles.
• Increase your activity gradually to avoid overloading your knees.
• Use proper form and technique during physical activities.
• Avoid pushing through pain and give yourself rest when needed.

Don’t let knee pain slow you down. At Banner Health, our orthopedic experts and physical therapists are ready to help you get back to the activities you love. Schedule an appointment today and take the first step toward pain-free movement.