Patellofemoral pain syndrome

Expert reviewer, Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
Next review due December 2023

Patellofemoral pain syndrome is a general term that describes pain at the front of your knee, behind, or around your kneecap (patella). It’s thought to be a result of stress on the joint between your kneecap and your thigh bone (femur).

About patellofemoral pain syndrome

Patellofemoral pain syndrome is one of the most common causes of knee pain, and causes around one in four knee injuries seen in sports medicine clinics. Although anyone can get it, it’s more common in women and people in their twenties and thirties. Patellofemoral pain syndrome is sometimes called ‘runner’s knee’ because it’s particularly common in people who run, but you can get it doing other sports too.

Causes of patellofemoral pain syndrome

The exact reasons why you can develop patellofemoral pain syndrome aren’t known. But it’s probably caused by a combination of things. It often develops as a result of overuse – for instance, if you have repeated stress on your knee during sports. It can also be triggered by a sudden change in how often you exercise, or how long you exercise for.

You’re more likely to get patellofemoral pain syndrome if there’s a structural problem affecting the joint between your kneecap and thigh bone. This can include minor problems in the alignment of your knee joint and weakness in the muscles around your hip or thigh. These problems can affect the way your knee joint moves, and cause pain.

Symptoms of patellofemoral pain syndrome

Patellofemoral pain syndrome can affect one or both of your knees. The main symptom of patellofemoral pain syndrome is a dull, aching pain, which you feel around and in front of your knee, but sometimes at the back of your kneecap. The pain will usually start gradually and get worse if you do a lot of activity.

The pain may be especially bad when doing activities where you need to bend your knee, such as going up and down stairs, or doing squats. It can also be painful when sitting with your knees bent for a long time, for instance in the cinema.

You may get crackling or crunching sounds in your knee when you bend or straighten it too.

Self-help for patellofemoral pain syndrome

You’ll need to reduce the amount of activity you do that causes you pain, such as running less, or having a complete break. You could try some alternative exercises that put less stress on your knee, such as swimming and cycling, to keep your fitness up.

If you have any swelling, put an ice compress on your knee. Leave it for 15 to 20 minutes at a time, every two to three hours. This may be especially helpful after you’ve been active. Don’t put ice directly on your skin as it can burn your skin – place a cloth between the ice and your skin.

Treatments for patellofemoral pain syndrome

The initial treatment for patellofemoral pain syndrome is to tackle your pain. You can do this by reducing any activities that cause pain and using ice to reduce pain and inflammation (see self-help above). Medicines will also help to reduce pain and inflammation. Further treatment includes stretching and strengthening exercises with physiotherapy to gradually get you back to your usual activities. Most people recover after about four to six weeks.

You may find it helpful to see a sports medicine professional, such as a physiotherapist, sports doctor or an orthopaedic doctor (a doctor who specialises in bone conditions). Your GP may be able to refer you, or you can book an appointment with a physiotherapist yourself.

Medicines for patellofemoral pain syndrome

You can buy non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (painkillers) over the counter. These may provide short-term pain relief of patellofemoral pain for a couple of weeks. If your pain is really bad, your GP may be able to prescribe stronger NSAIDs if you need them. Always read the patient information that comes with your medicine, and if you have questions ask your pharmacist or GP for advice.

Physiotherapy for patellofemoral pain syndrome

Your physio will carefully assess your knee, and then plan an individual programme of rehabilitation exercises. These will help strengthen your knee and leg muscles. The exercises may include stretching and specific strengthening exercises, as well as exercises to improve the range of motion of your knee. Make sure you do these exercises as they’re an important part of your recovery.

Other treatments your physio may suggest include the following.

• Manual therapies, such as massage or manipulation of your knee joint may help improve your symptoms.
• Wearing orthoses (inserts in your shoes) may help to reduce pain and improve function. You can buy these from a pharmacy or online – your physio can advise you on what to buy or may refer you to see a podiatrist to have them fitted.
• Taping your knee or wearing a support brace may help with pain before you do your exercises. It’s unclear how effective these supports are – but they seem to be helpful for some people.

Surgery for patellofemoral pain syndrome

People with patellofemoral pain syndrome rarely need surgery. But it may be an option if you have severe, persistent pain, and other treatments have failed.