What is patellofemoral pain?
Patellofemoral pain syndrome describes pain arising from the joint between the kneecap (patella) and the groove in the thigh bone it glides along. When the kneecap does not track smoothly through that groove, the surfaces are loaded unevenly and the front of the knee becomes painful.
It is sometimes called “runner’s knee,” though it affects far more than runners. Importantly, it is usually a problem of mechanics and load — not structural damage — which is why it responds so well to targeted exercise.
Signs and symptoms
- checkA dull ache at the front of the knee around or behind the kneecap.
- checkPain on stairs particularly going down, and on slopes.
- checkDiscomfort after prolonged sitting (the “cinema sign”), with the knee bent.
- checkA grinding or clicking sensation as the kneecap moves.
Causes & risk factors
The pain usually reflects a combination of factors that pull the kneecap slightly off its ideal path or overload it:
- Weakness or imbalance in the thigh and hip muscles.
- A rapid increase in training load or distance.
- Tightness in the muscles around the knee and hip.
- Foot mechanics, such as flat feet, altering alignment.
How it is diagnosed
Diagnosis is largely clinical: a careful history and an examination of how the kneecap tracks, the strength of the hip and thigh, and which movements reproduce the pain. Imaging is usually unnecessary, and is reserved for cases that do not settle as expected.
Treatment options
The cornerstone of treatment is a structured exercise programme that restores balanced strength and movement — surgery is very rarely needed.
Targeted strengthening
Strengthening the hip and thigh muscles to correct tracking is the single most effective treatment.
Load management
Temporarily modifying training, then rebuilding gradually, settles the irritated joint.
Taping & orthotics
Patellar taping or footwear adjustments can ease symptoms while strength is rebuilt.
Front-of-knee pain almost never needs an operation. It needs the right rehabilitation — and the patience to let strength catch up with ambition.
Recovery & outlook
Most patients improve substantially within a few weeks to a few months of consistent rehabilitation, and go on to return fully to their sport. The key to staying pain-free is maintaining the strength gains and increasing training load gradually rather than in sudden jumps.