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Understanding Patellofemoral Syndrome: Causes, Symptoms, and Treatment

A tennis player, wearing white attire and wristbands, sits on a bench with hands clasped and elbows resting on knees. The legs and tennis shoes of the player are muddy, suggesting they have been playing. The background features a green fence and court.

Patellofemoral Syndrome (PFS), commonly referred to as runner’s knee, is a condition that causes pain around or behind the kneecap, aggravated by activities that load or compress the patellofemoral joint. This ailment is particularly prevalent among athletes and physically active individuals, though it can affect anyone. The syndrome encompasses a range of symptoms related to the patella, or kneecap, which arises due to issues with its alignment and movement as it glides through the femoral groove.

Causes of Patellofemoral Syndrome

Understanding the causes of Patellofemoral Syndrome is crucial for prevention and effective treatment. The exact cause can vary between individuals, but several common factors contribute to its development:

  1. Overuse: Engaging in repetitive activities that place stress on the knee, such as running, jumping, or squatting, can lead to inflammation and pain in the patellar region. The constant pounding and pressure can cause irritation in the soft tissues around the kneecap.
  2. Muscle Imbalance: Weakness or imbalance in the muscles that support the knee joint, particularly the quadriceps, hamstrings, and hip muscles, can result in improper tracking of the patella. When these muscles are not working harmoniously, the patella can be pulled out of alignment, leading to increased stress and pain.
  3. Improper Footwear: Wearing shoes that do not provide adequate support or that are worn out can alter an individual’s gait. This change in walking or running mechanics can increase the stress placed on the knees, contributing to the development of PFS. Proper footwear is essential to maintain correct alignment and reduce undue pressure on the knees.
  4. Structural Abnormalities: Anatomical issues such as flat feet, high arches, or malalignment of the legs can predispose individuals to abnormal patellar tracking. These structural differences can affect the way the patella moves within the femoral groove, increasing the risk of irritation and pain.
  5. Previous Injury: Individuals with a history of knee injuries, such as ligament tears or fractures, are more susceptible to developing PFS. Previous injuries can weaken the structures around the knee, making it more vulnerable to overuse and misalignment.

Symptoms of Patellofemoral Syndrome

A person wearing blue athletic gear is sitting on the floor, touching their knee with both hands, possibly indicating knee pain or discomfort. Another individual in the background is also seated and touching their own knee.

Recognizing the symptoms of Patellofemoral Syndrome is key to seeking timely treatment and preventing further complications. The primary symptom is pain around the kneecap, which can vary in intensity and may be accompanied by several other signs:

  • Pain during activities: Pain typically worsens with activities that place pressure on the knee when the knee is flexed, such as running, squatting, or climbing stairs. This pain can be sharp or dull and is often exacerbated by prolonged periods of sitting with bent knees or by sudden increases in physical activity.
  • Crepitus: A grinding or crackling sensation may be felt when bending or extending the knee. This sensation, known as crepitus, is caused by the roughening of the cartilage on the underside of the patella, which creates friction as it moves against the femur.
  • Swelling: Mild swelling around the kneecap can occur, especially after activities that put significant stress on the knee. This swelling is often a result of inflammation in the soft tissues surrounding the patella.
  • Knee giving way: Some individuals may experience a sensation of the knee buckling or giving way, which can be particularly disconcerting during physical activities. This instability is usually due to muscle weakness or improper patellar tracking.

Diagnosis of Patellofemoral Syndrome

Diagnosing Patellofemoral Syndrome requires a comprehensive evaluation by a healthcare provider, which typically involves:

  1. Patient History: A detailed history of symptoms, activity level, and any previous injuries is crucial for an accurate diagnosis. Understanding the patient’s lifestyle, exercise routine, and any recent changes in physical activity can help identify potential causes of PFS.
  2. Physical Examination: The healthcare provider will assess the knee’s range of motion, alignment, and areas of tenderness. They may also perform specific maneuvers to evaluate patellar tracking and identify any muscle imbalances or structural abnormalities.
  3. Imaging Studies: X-rays, MRI, or CT scans may be used to rule out other conditions and assess the alignment of the patella. These imaging techniques can provide detailed views of the knee joint, helping to identify any underlying issues contributing to PFS.

Treatment of Patellofemoral Syndrome

A physical therapist in a white shirt assists a patient lying down on a black treatment table. The therapist holds the patient's leg, which is bent at the knee and dressed in gray leggings. The setting appears to be a bright, modern physiotherapy clinic.

The goal of treatment for Patellofemoral Syndrome is to alleviate pain, improve function, and address any underlying causes. Treatment approaches can be broadly categorized into conservative and surgical methods:

  1. Physical Therapy: A targeted physical therapy program can help strengthen the quadriceps, hamstrings, and hip muscles, improve flexibility, and correct muscle imbalances. Physical therapists may also use techniques such as taping or manual therapy to improve patellar alignment and reduce pain.
  2. Rest and Activity Modification: Reducing or modifying activities that aggravate the knee is often the first step in treatment. This allows time for inflammation to subside and can prevent further damage. Activities that place significant stress on the knees should be minimized or replaced with low-impact exercises, such as swimming or cycling.
  3. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help manage pain and reduce inflammation. Ice application to the affected area can also be effective in reducing swelling and alleviating discomfort.
  4. Orthotics and Footwear: Using supportive shoes and orthotic inserts can help correct foot alignment and reduce stress on the knees. Orthotics may be recommended for individuals with significant structural abnormalities, such as flat feet or high arches.
  5. Taping: Techniques like patellar taping can be used temporarily to help properly align the patella and alleviate pain. These methods can provide additional support during physical activities and help prevent further injury.
  6. Surgery: In severe cases that do not respond to conservative treatments, surgical options may be considered. Surgery is typically reserved for cases where there is significant structural damage or chronic pain that severely impacts the individual’s quality of life.

Prevention of Patellofemoral Syndrome

Preventing Patellofemoral Syndrome involves addressing risk factors and incorporating preventive measures into daily routines:

  • Strength Training: Regular exercises to strengthen the muscles around the knee, particularly the quadriceps, hamstrings, and hip muscles, can improve overall stability and reduce the risk of PFS. Strength training should focus on both the major muscle groups and the smaller stabilizing muscles.
  • Stretching: Incorporating flexibility exercises for the quadriceps, hamstrings, and calves can help maintain a full range of motion and prevent muscle tightness. Stretching should be done regularly, both before and after physical activity, to ensure optimal muscle function.
  • Proper Footwear: Wearing shoes that provide adequate support and cushioning is essential for maintaining proper alignment and reducing stress on the knees. Footwear should be appropriate for the individual’s activity level and foot type, and should be replaced regularly to ensure continued support.
  • Gradual Progression: Increasing the intensity and duration of physical activities gradually can help avoid overuse injuries. A sudden increase in activity level can place excessive stress on the knees, leading to inflammation and pain. A gradual progression allows the body to adapt and strengthen over time.
  • Cross-Training: Engaging in a variety of physical activities can help distribute the stress placed on the knees and reduce the risk of overuse injuries. Cross-training can include low-impact activities such as swimming, cycling, or yoga, which can improve overall fitness without placing excessive strain on the knees.


Patellofemoral Syndrome is a common condition that can significantly impact an individual’s ability to perform daily activities and engage in sports. Understanding its causes, recognizing symptoms early, and seeking appropriate treatment are crucial for effective management. With proper care and preventive measures, individuals with Patellofemoral Syndrome can achieve significant improvements in pain relief and knee function, enabling them to return to their regular activities. By incorporating strength training, stretching, proper footwear, gradual progression, and cross-training into their routines, individuals can reduce their risk of developing PFS.

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Dr. John DeVries

Freedom Physical Therapy and Wellness

We help those frustrated with their current physical status get back to doing the things they enjoy.