17914 Patellofemoral Pain Syndrome Pfps

Overview

Patellofemoral pain syndrome (PFPS) is pain at the front of the knee, around or behind the kneecap. The kneecap is also called the patella. The pain usually happens when the kneecap does not glide smoothly over the thigh bone during movement. It is not usually due to a serious injury or joint damage.

Yes. PFPS is one of the most common knee problems seen in family medicine, particularly in teenagers, young adults, and people who are active in sport.

It can affect people of any age, but it is more common in runners, athletes, women, and teenagers going through a growth spurt.

Symptoms

Common symptoms

• A dull ache or sharp pain around or behind the kneecap
• Pain when walking up or down stairs
• Pain after sitting for a long time with knees bent
• Pain during squatting or kneeling, sometimes with a crackling feeling
• Pain at the start of a run that may ease then return

Symptoms in children

• Children and teenagers may feel pain in one or both knees during sport.
• They may complain of aching after sitting cross-legged or in a bent-knee position.
• They might avoid full squats or say the knee feels weak.

Symptoms in older adults

• Older adults may notice pain when getting up from a chair, walking downhill, or going down stairs.
• The pain can feel similar to arthritis, but PFPS itself is a separate condition.
• Daily activity may be reduced until the muscles around the knee are strengthened.

Causes

Main causes

• Muscle weakness or imbalance around the hip and thigh, which affects how the kneecap moves
• Tightness in the thigh, hamstring, or calf muscles
• A sudden increase in running, jumping, or stair climbing
• Foot problems such as flat feet or excessive inward rolling of the foot

Risk factors

• Playing running, jumping, or squatting sports
• Being female
• Being a teenager or young adult
• A previous knee injury
• Sudden changes in training intensity or footwear

When to see a doctor

See a doctor urgently if:

• Go to same-day medical care if your knee gives way and you cannot stand.
• Go to same-day medical care if your knee locks or cannot fully straighten.
• Seek same-day medical care if you have sudden swelling or fever with knee pain.

Book a routine appointment if:

• Make a routine appointment if knee pain lasts more than two weeks.
• Make a routine appointment if the pain is getting worse or stopping you from daily activities.
• Make a routine appointment if you keep needing to change your exercise routine because of knee pain.

Diagnosis

A doctor or physiotherapist can usually diagnose PFPS by asking about your symptoms and examining both knees. They will want to know what makes the pain better or worse, your activity level, and whether there was any injury.

Tests that may be done

• A discussion about your symptoms and activities
• A physical exam, including checking strength, flexibility, and how the kneecap moves
• Observing you walk, squat, and climb a step if possible
• Imaging tests like X-ray or ultrasound only if another knee condition is suspected

What to expect at your appointment

The clinician may press gently around the knee and ask you to do a few movements. This can feel uncomfortable but it is useful and should not cause lasting harm. Afterwards, they will usually suggest exercise and self-care steps, not a scan.

Treatment

Treatment for PFPS is almost always non-surgical. The main goal is to strengthen the muscles that support the knee, improve alignment, and gradually return to activity. Recovery takes time, usually weeks to a few months.

Self-care at home

• Temporarily reduce painful activities like running, jumping, or deep squats
• Apply a cold pack wrapped in a cloth to the front of the knee for 10 to 15 minutes after activity
• Ask a pharmacist or doctor about safe pain relief options
• Wear comfortable, supportive footwear
• Avoid sitting with your knees bent for long periods if this brings on pain

Medical treatments

A healthcare professional may suggest a structured exercise programme with a physiotherapist, shoe inserts called orthotics if foot alignment is a factor, and temporary taping of the kneecap. Some people are offered advice about safe pain relief, but medication is not the main treatment for PFPS.

When is surgery considered?

Surgery is rarely needed. It may be discussed only if the knee problem continues after several months of supervised physiotherapy, or if a scan shows another specific injury inside the joint. A specialist would explain the risks and benefits before you decide.

Living with this condition

You can still be active while recovering, but you may need to change the way you exercise. Choose low-impact activities such as swimming, cycling with light resistance, or walking on flat ground. Follow your rehabilitation exercises consistently and build up slowly.

Lifestyle tips

• Warm up before activity and cool down afterwards
• Stretch your thighs, hamstrings, and calves gently
• Use well-fitting shoes with good support
• Increase exercise duration or difficulty gradually
• Listen to your body and do not push through sharp knee pain

Diet and exercise

A balanced diet with fruits, vegetables, lean protein, and calcium-rich foods can support your muscles and bones. Low-impact exercise is encouraged, but avoid high-impact movements that make the pain worse until your knee feels stronger.

Mental health and emotional wellbeing

Living with knee pain can feel frustrating, especially if it prevents you from doing activities you love. This is normal and important to share. Talking to your healthcare team, family, or friends can help, and getting back to movement gradually often improves mood as well as pain.

Prevention

Not every case can be prevented, but keeping the thigh and hip muscles strong, avoiding sudden increases in training, and wearing supportive shoes can lower the chances of PFPS.

Complications

If left untreated

• Pain may last for months and affect work, study, or sport
• Muscle weakness in the thigh may develop if you reduce activity too much
• Changes in the way you walk could lead to discomfort in the ankle, hip, or back

Long-term outlook

The outlook is very good. Most people improve with time, exercise, and small changes to their activity. Even if it takes longer than expected, full return to running and sport is realistic for most people with PFPS.

Find support

International organisations

• Versus Arthritis (UK) ↗

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