Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome, also known as PFPS or Runners Knee, is one of the most common musculoskeletal injuries seen by healthcare professionals.  It is most often seen in active individuals, and even more specifically within the running population.

Clinical Presentation

Patellofemoral Pain Syndrome is commonly characterized by generalized pain around or under the kneecap.  Individuals with this injury frequently report that their symptoms have appeared insidiously (without any obvious injury, such as a twist or fall).  They often report that the pain is exacerbated during activities such as kneeling, squatting, running, walking/running downhill and descending stairs.  Pain during a period of prolonged knee flexion (bend) is also very common (known as the “moviegoers sign”).  Clicking or grinding (“crepitus”) of the kneecap can also be reported, especially during chronic cases of PFPS.

Anatomy & Physiology

The Patellofemoral Joint is compromised of 2 bones: the 1st being the Patella (kneecap) and the 2nd being the Femur (upper thigh bone).  When the knee bends and straightens, the Patella glides within a groove on the end of the Femur, called the Trochlear Groove.  To put it simply, PFPS happens as a result of the patella tracking abnormally within this groove over time.  This causes abnormal stress on the tissues within and surrounding the joint, eventually leading to pain.

There are numerous factors that can contribute to the onset of this condition, only some of which are listed below:

  • Muscular weakness (gluteus musculature, hip rotators, quadriceps)
  • Soft tissue inflexibility (Quadriceps, IT Band, Tensor Fascia Latae)
  • Increased Q-Angle – often greater in females (see pic)
  • Over-pronation (excessive rolling-in of the foot)
  • Poor dynamic control of the lower extremity
  • Inappropriate footwear – this can be an improperly fitted shoe, or simply just shoes that have worn out

The majority of the time, the cause of this condition is multifactorial.  PFPS is an example of an injury where the underlying cause of the symptoms is more commonly found outside of the knee itself. It is frequently a combination of issues both proximally (above the knee) and distally (below the knee) which contributes to the functional malalignment of the lower extremity and resulting dysfunctional tracking of the patella.

Prevention & Treatment

As you can now see, it is often factors other than the knee itself that are the underlying cause of PFPS.  Therefore, a thorough assessment and individualized treatment program must be created for each individual in order to treat the root cause of the problem.

Both prevention and treatment of this condition will focus on a progressive core/hip strengthening program, as there is a strong correlation between gluteal weakness and individuals with PFPS.  Education and awareness about lower extremity alignment during movement, stretching for soft tissue inflexibility, as well as footwear assessment & correction, are also typically included in one’s rehabilitation program.  In addition, orthotics, bracing and taping techniques may be utilized to correct faulty mechanics and manage symptoms, allowing individuals to maintain an active level of function during their rehabilitation process.

Please consult with your health care provider if you wish to discuss your PFPS symptoms further.  If you have any questions specific to this article please contact:

Teresa Agar, MScPT, BHKin
Registered Physiotherapist

Trailside Physio – Coquitlam Clinic

  • Judit Medve

    July 21, 2020 at 6:08 am Reply

    Dear Kintec,
    I am a physio student and I would like ask about my friend’s knee who most probably has PFPS.
    Could I ask how can I make difference between Iliotibial friction syndrome and PFPS?
    He has pain below the right side of the patella, and right femoral epicondyle which fits in both pathologies’ feature.
    Moreover, does taping technique helps in this case something?

    • Michael Ryan - Director of R&D

      July 22, 2020 at 1:54 pm Reply

      Hi Judit, The presentation of pain is often quite different between ITBFS and PFPS. ITBFS is often sharp, location specific pain during exercise and gets progressively worse until limiting exercise; the patient will want to avoid flexing the affected knee. PFPS can appear during activity and is usually characterized by diffuse soreness around the kneecap. PFPS can sometimes feel worse after exercise. Taping can be particularly helpful for PFPS during exercise.

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