Patellofemoral Pain Syndrome (PFPS), often called “runner’s knee,” is a common condition causing pain around or behind the kneecap. It affects athletes, active individuals, and even those with less active lifestyles.
PFPS typically arises due to muscle imbalances, improper knee mechanics, or overuse, leading to irritation of the patellofemoral joint. While the pain can be frustrating, PFPS treatment can help relieve symptoms, restore function, and stop the pain from coming back. The best approach is conservative management, including physiotherapy.
In this article, we’ll explore the causes, symptoms, and best physiotherapy strategies to effectively manage PFPS and keep you moving pain-free.
Table of Contents:
Causes of PFPS
The main causes of PFPS include factors that affect the movement of the patella (kneecap) within the femoral groove (area at the end of the thigh bone). The causes of PFPS typically include any muscle or ligament affecting the joint mechanics at the knee. The most common causes of PFPS include:
Overuse and Repetitive Stress
Activities that involve frequent knee bending, such as running, squatting, jumping, or cycling, can put excessive stress on the patellofemoral joint. Sudden increases in how much you train or how hard you train can overload the knee, leading to irritation.
Muscle Imbalances and Weakness
Weakness in the thigh muscles (especially the inner quadriceps) can make the kneecap move improperly. Additionally, weak hip muscles, like the gluteus medius, can cause poor knee alignment, adding stress on the patellofemoral joint.
Poor Biomechanics and Alignment Issues
Flat feet (overpronation) or high arches can alter leg mechanics, affecting how forces are distributed across the knee. Knock knees (genu valgum) or excessive inward knee movement (dynamic valgus) can increase stress on the kneecap. Tight iliotibial (IT) band, hamstrings, or calf muscles can also contribute to improper knee movement.
Improper Training Techniques
Poor running form, inadequate warm-ups, or training on hard or uneven surfaces can increase knee strain. Wearing shoes that lacks support can also make things worse.
Trauma or Injury
A direct blow to the kneecap, such as a fall or collision, can cause patellofemoral pain. Previous knee injuries may alter movement patterns, increasing the risk of PFPS.
Symptoms of PFPS
The most noticeable symptom is pain at the front of the knee. It is often worse when loading a flexed knee such as in activities like running, climbing stairs and squatting.[i] The pain often gets worse over time if the underlying causes of the knee pain aren’t addressed.
PFPS Treatment
The best approach for PFPS treatment is conservative management including physiotherapy. A physiotherapist will perform a thorough assessment including subjective history and objective testing of strength, muscle length, joint movement, gait analysis and postural analysis.
Research shows that physiotherapy is effective for managing PFPS pain.[ii] Physiotherapy intervention may include:
- Pain relief techniques – heat, ice, ultrasound, laser therapy, acupuncture
- Strengthening exercises – strengthening of quadriceps muscles, particularly VMO and gluteus medius
- Stretching exercises – lengthening of any tight musculature in particular the iliotibial band and hamstrings that are commonly shortened with this condition
- Patellar taping – taping can be used to help relieve pain and retrain proper movement of the muscles that surround the kneecap
- Manual therapy – to help release any restrictions impacting range of motion
- Orthotics – getting supportive footwear for low arches can help postural alignment that can be contributing to pain
- Education – regarding the importance of early management and continued stretching and strengthening
Why Early Treatment Matters
In my experience as a physiotherapist and a runner, I’ve seen how early PFPS treatment is key in preventing pain and further complications. Following a tailored program of strengthening and stretching is essential in preventing injuries and pain-free activities.
Physiotherapy is highly effective in managing Patellofemoral Pain Syndrome because it addresses the root causes, improves knee mechanics, and restores pain-free movement.
Through a combination of targeted exercises, manual therapy, and movement retraining, physiotherapy helps strengthen key muscle groups, correct imbalances, and reduce stress on the patellofemoral joint.
With a personalized rehabilitation plan, you can relieve pain and also prevent future flare-ups, helping you to return to your daily activities and sports with confidence.
If you’re experiencing knee pain, seeing a physiotherapist can be the first step toward long-term relief and improved knee health.
References
[i] Bump JM, Lewis L. Patellofemoral Syndrome. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557657/
[ii] Petersen, W., Ellermann, A., Gösele-Koppenburg, A. et al. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc 22, 2264–2274 (2014). https://doi.org/10.1007/s00167-013-2759-6
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