What is Patellofemoral Pain Syndrome?

Patellofemoral Pain Syndrome (PFPS), also known as runner’s knee, is a common condition characterised by pain at the front of the knee, around or behind the kneecap (patella). It occurs when the patella does not track properly in the femoral groove, leading to irritation of the surrounding tissues. PFPS is one of the most frequent causes of anterior knee pain in athletes and active individuals.

What happens in PFPS?

PFPS develops gradually and often worsens with repetitive activities such as running, squatting, climbing stairs, or sitting for long periods. Unlike ligament injuries, PFPS is not typically associated with a single traumatic event, but rather with biomechanical overload and poor knee alignment.

Common causes

  • Overuse from running, jumping, or squatting
  • Weakness or imbalance in the quadriceps, hips, or glutes
  • Poor patellar tracking due to malalignment
  • Flat feet or overpronation
  • Tight iliotibial band or hamstrings
  • Sudden increases in training load

Who is most affected?

  • Runners, footballers, and netball players
  • Young athletes and adolescents
  • Females (higher risk due to wider pelvic angle and biomechanics)
  • Office workers who sit for long periods
  • In Australia, PFPS is one of the leading causes of knee pain in people under 30

Symptoms of PFPS

  • Dull, aching pain at the front of the knee
  • Pain worsens with stairs, squatting, or prolonged sitting ('moviegoer’s knee')
  • Clicking or grinding sensation under the patella
  • Swelling may be mild or absent
  • Pain during running, particularly downhill

📞 If you have persistent knee pain that worsens with activity, book an assessment at Spinal and Sports Care Bella Vista or Parramatta.

Diagnosis of PFPS

Clinical Tests:

  • Patellar grind test (Clarke’s test)
  • Step-down test
  • Single-leg squat assessment
  • Gait analysis for biomechanics

Imaging:

  • X-rays: To rule out arthritis, fractures, or structural issues
  • MRI: Not always required but can help rule out cartilage or soft tissue pathology
  • Ultrasound: Sometimes used to assess tendon involvement

Treatment options

PFPS is usually managed non-surgically. Early diagnosis and rehabilitation are key.

Non-surgical:

  • Load management and activity modification
  • Physiotherapy-led strengthening program (quads, glutes, hips)
  • Stretching of ITB, hamstrings, and calves
  • Patellar taping (McConnell taping) to improve patellar alignment
  • Foot orthotics for flat feet or overpronation

Surgical:

  • Rarely required
  • Only considered if conservative management fails after 6–12 months
  • May involve arthroscopy or realignment procedures

Role of physiotherapy

  • Correct muscle imbalances (VMO activation, hip strengthening)
  • Improve movement patterns and biomechanics
  • Progressive return-to-sport rehabilitation
  • Education on footwear, training loads, and knee-friendly exercise choices

Recovery timeline

  • Mild cases: 4–6 weeks
  • Moderate cases: 2–3 months
  • Severe or chronic cases: up to 6–12 months

Injury grading

  • Mild: Pain only after activity
  • Moderate: Pain during activity and daily tasks
  • Severe: Persistent pain affecting daily function and sport

Prevention of PFPS

  • Strengthen quadriceps, glutes, and hips
  • Avoid sudden increases in training load
  • Use proper footwear and running surfaces
  • Warm up and stretch before exercise
  • Neuromuscular training programs (e.g., FIFA 11+, Netball Knee Program) help reduce knee pain incidence

Taping and bracing

  • McConnell taping can improve patellar tracking and minimise pain
  • Patellar stabilising braces may be useful during sport

When to see a physiotherapist or chiropractor

📞 If knee pain persists for more than 1-2 weeks or interferes with sport, consult Spinal and Sports Care for expert assessment.

Frequently Asked Questions

A condition causing pain around the kneecap due to poor patellar tracking and overuse.

Yes, PFPS is commonly referred to as runner’s knee.

PFPS is one of the most common knee complaints in young athletes, affecting up to 25% of runners and netball players.

Running, netball, football, basketball, and sports with repetitive jumping and squatting.

Symptoms may persist or worsen without proper management. Physiotherapy is strongly recommended.

Not usually, but if untreated, it can lead to chronic pain and patellofemoral osteoarthritis.

Ranges from 4 weeks in mild cases to 6–12 months in chronic cases.

Some patients can continue with modified training, but reducing load and seeking physiotherapy is important.

McConnell taping can reduce pain immediately by improving patellar alignment.

Through strength training, proper footwear, and neuromuscular prevention programs.