Patellofemoral Pain Syndrome: A Complete Patient Guide

Patellofemoral Pain Syndrome: A Complete Patient Guide

By Jenny McConnell AM, FACP. B.App.Sc.(Phty), Grad.Dip.Man.Ther, M.Biomed.Eng.

You probably know the ache. It shows up on the way down the stairs, or when you stand up after sitting through a movie with your knees bent. Or you get out of the car after a long drive and the first few steps feel stiff and sore.

If that sounds familiar, you may have patellofemoral pain syndrome. It's the most common cause of knee pain in people who haven't had a specific injury, and it usually responds well to the right program.

This guide explains what it is, what causes it, what a scan can and can't tell you, and what actually helps.

What is patellofemoral pain syndrome?

Patellofemoral pain syndrome (PFPS) is pain at the front of the knee, around or behind the kneecap. It comes from the way the kneecap moves against the thigh bone (femur) beneath it. The kneecap sits in a shallow groove at the end of the femur and glides along it as you bend and straighten your knee. If it doesn't track through the center of that groove, the load isn't shared evenly, and the tissues taking the extra load become irritated.

It's a bit like the wheel alignment on a car. Nothing is broken, but the alignment is slightly off, so one side wears faster than it should.

You may also hear it called runner's knee, anterior knee pain or, in older texts, chondromalacia patellae. International consensus has tidied up the terminology over the years, and most clinicians now call it patellofemoral pain.

Who gets it?

It's common in runners, cyclists and anyone whose sport involves squatting, jumping or stairs. Teenagers get it often too, because their bones can grow faster than the surrounding soft tissues, and so do people who sit with their knees bent for long periods.

You may be more likely to develop it if your kneecaps point slightly inward when you stand, you have flat feet, or your knee wobbles inward when you go down stairs or squat on one leg.

Where does the pain come from?

It isn't the cartilage. Cartilage has no nerve supply, which is why the amount of wear seen on a scan often has little to do with how much a knee hurts.

The pain usually comes from the soft tissues around the kneecap, especially the fat pad just below it, which has a rich supply of pain sensitive nerve endings.

This is also why the problem can keep itself going. Pain makes the quadriceps work less effectively, especially the inner part that helps guide the kneecap. When that muscle fires late or weakly, it can't guide the kneecap as well, so tracking gets worse and the pain increases.

Focused physical therapy can break that cycle. Tape is used not only to position the kneecap in the groove of the thigh bone, but also to shorten the inner part of the quadriceps, known as the VMO (vastus medialis obliquus). Taping has been shown to help the VMO switch on earlier during activities like stepping up and down stairs. Combined with a program you stick with, this approach has been shown to significantly reduce pain and improve function.

Why the hip and foot matter too

Many people are surprised to learn that the kneecap doesn't control its own position. It responds to what the bones above and below it are doing.

Above the knee, poor control from the hip muscles can let the thigh bone rotate inward under the kneecap when you squat, step or land. In that case the kneecap hasn't really moved sideways, because the groove has turned underneath it. Below the knee, a foot that rolls in a lot can rotate the shin and cause a similar problem from the other direction.

How much each of these contributes varies from person to person, which is why a proper assessment works better than a generic exercise sheet. Two people with the same knee pain may need quite different programs.

What a scan can and can't tell you

If you've had an X-ray or MRI, the report may have mentioned wear, degeneration or chondromalacia. These findings are common, become more likely with age, and often show up in knees that don't hurt at all.

A scan is useful for ruling out other problems, but it's much less helpful for explaining your pain or predicting how you'll recover. Imaging findings aren't necessarily permanent either.

In practice, how your knee behaves under load matters more than what shows up on a scan. Our guide to the causes of knee pain covers this in more detail.

What actually helps

The approach to treating patellofemoral pain has held up well over time. It involves working out what's causing the poor tracking in your case, and then retraining the muscles that control it. That framework dates back to the treatment program first published in 1986, and clinical trials have refined it since.

A physical therapist can assess your hip control, foot posture and flexibility, then give you exercises that target your specific problem rather than a generic set. Most people get better without surgery.

Taping plays a specific role in that program. Repositioning the kneecap with firm, non-stretch tape reduces pain enough for you to do the retraining properly, which matters because exercising through pain doesn't build the control you need. So taping isn't the treatment on its own, but it makes the treatment possible. Our McConnell taping page explains how the technique works.

If a physical therapist has shown you the technique, our step by step guide to taping your knee takes you through it, and there's a video tutorial too.

How long does it take?

Usually longer than people hope, and it varies. How your knee feels with the tape on gives a useful early clue. If taping settles the pain a lot, the mechanical side of the problem is likely to be treatable and the retraining has something to build on.

If you're still sore with the tape on, the tape may not have been applied quite right, or the fat pad under the kneecap may not have been unloaded enough. It can also mean something else needs attention first.

Patellofemoral pain syndrome is managed rather than cured. Plenty of people get comfortable and stay that way, return to running and sport, and get on with life. The most common reason it comes back is stopping the work that settled the pain and got you back to the activities you love.

Where to start

Patellofemoral pain syndrome is a problem with how the kneecap tracks and how the muscles control it. It isn't a sign that your knee is wearing out. The hip and foot play as big a part as the knee, scans don't explain it well, and it responds to a proper assessment followed by targeted retraining.

That assessment is the place to begin, so see a physical therapist first. Everything else builds on it.

For the taping side of things, our Combo Pack includes the Under Tape and Rigid Tape used for this technique. Under Tape goes against the skin first, with Rigid Tape applied over the top.

The research behind this article

This blog is for educational purposes only and does not replace professional medical advice. Always consult a healthcare provider for diagnosis and treatment.

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