Patellofemoral Pain Syndrome

A dull ache at the front of the knee — around or behind the kneecap. Pain on stairs — particularly going down, and on slopes. Discomfort after prolonged sitting — (the “cinema sign”), with the knee bent. A grinding or clicking sensation — as the kneecap moves.

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.

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.

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.

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.