If you’ve ever had aching or discomfort at the front of your knee—especially around or behind your kneecap—you might be dealing with something called patellofemoral pain. This type of knee pain is especially common in active individuals, but it can affect anyone.
Let’s break down what it means, why it happens, and how you can manage it.
What Is Patellofemoral Pain?
The knee is a complex joint made up of several parts, one of which is the patellofemoral joint—where your kneecap (patella) glides over your thigh bone (femur). This joint is designed to handle loads when you walk, run, climb stairs, or squat.
But when the kneecap isn’t moving properly, or the joint is under too much stress, it can cause irritation and pain. That’s what we call patellofemoral pain syndrome (PFPS).
What Causes It?
There are a few key reasons why pain develops in the patellofemoral joint:
1. Muscle Imbalance
Sometimes, the muscles that control your kneecap aren’t working evenly. If the inner thigh muscle (called the vastus medialis) is weaker than the outer thigh muscle (vastus lateralis), the kneecap can get pulled sideways, causing pain.
2. Poor Patella Tracking
Your kneecap should move smoothly in a groove on the thigh bone. But if it’s misaligned or pulled off track (called “maltracking”), pressure builds up on one side of the joint.
3. Hip and Glute Weakness
Weak glutes and hip stabilisers can lead to poor leg alignment during walking or running. This affects how your kneecap moves and can lead to pain.
4. Foot Mechanics
If your feet roll inwards (a condition called pronation), it can twist your lower leg and change how forces move through the knee. This can stress the patella.
5. Overuse and Impact
Activities that involve lots of bending, kneeling, or running (especially downhill) can overload the joint. Over time, this can wear down the cartilage behind the kneecap, a condition known as chondromalacia patella.
What Does It Feel Like?
Common symptoms of patellofemoral pain include:
- A dull ache at the front of the knee
- Pain when going up or down stairs
- Discomfort after sitting for a long time
- Clicking or grinding when you bend or straighten the knee
What Can Help?
Most people recover well with the right treatment. Your physio might recommend:
- Strengthening exercises for the glutes, hips, and inner thigh
- Stretching for tight muscles like the outer thigh or calves
- Footwear advice or orthotics if you have flat feet or pronation
- Activity modification to reduce joint stress while you heal
- Hands-on therapy to help with stiffness or joint alignment
- Education on posture, alignment, and pain management
When Should You See a Physio?
If your knee pain has lasted longer than a few weeks, or it’s getting in the way of your usual activities, it’s time to get it checked. A physiotherapist can assess your movement, identify any contributing factors, and tailor a rehab program just for you.
References
- Dixit, S., DiFiori, J. P., Burton, M., & Mines, B. (2007). Management of patellofemoral pain syndrome. American Family Physician, 75(2), 194–202.
- Lankhorst, N. E., Bierma-Zeinstra, S. M. A., & van Middelkoop, M. (2013). Factors associated with patellofemoral pain syndrome: a systematic review. British Journal of Sports Medicine, 47(4), 193–206. https://doi.org/10.1136/bjsports-2011-090369
- Mayahi, R., Erturan, G., Jackson, W., & Price, A. (2015). The Knee. In M. C. Hochberg et al. (Eds.), Rheumatology (6th ed., pp. 633–646). Mosby. https://doi.org/10.1016/B978-0-323-09138-1.00077-2
- Nuttall, C., & Winters, B. A. (2015). Understanding anterior knee pain: Patellofemoral pain syndrome. Journal for Nurse Practitioners, 11(10), 1032–1035. https://doi.org/10.1016/j.nurpra.2015.08.029
- Patellofemoral Pain Syndrome. (2021). Physiopedia. Retrieved April 29 from https://www.physio-pedia.com/Patellofemoral_Pain_Syndrome
