Patellofemoral Pain

Patellofemoral pain is pain at the front of the knee, under or around the kneecap (patella). PFP is one of the most common types of knee pain experienced in the United States. It often occurs among athletes, active teenagers, older adults, and people who perform physical labor. Patellofemoral pain affects more women than men. It accounts for 20% to 25% of all reported knee pain. Physical therapists design treatment programs for people with PFP to help reduce pain and improve function.

What Is Patellofemoral Pain?

PFP may occur after a sudden increase in activities like running or jumping. Research suggests that PFP results from activity levels that are increased faster than the knee can adapt. Other contributing factors to PFP may include:

  • Weakness of the thigh muscles.
  • Specializing in a single sport, which requires repeating the same movements again and again.
  • Certain hip and knee coordination patterns during running and jumping activities.

PFP does not go away on its own. If you have symptoms of PFP, it’s important to seek care from a physical therapist so you can return to the activities that you enjoy.

How Does It Feel?

People with PFP may experience pain:

  • When walking up or down stairs or hills.
  • When playing a sport.
  • With deep knee bending (squatting).
  • When walking on uneven surfaces.
  • With activity, but improving with rest.
  • After sitting for long periods of time with the knee bent.

How Is It Diagnosed?

Your physical therapist will review your health history and conduct a series of tests to evaluate you and your knee. PFP is diagnosed by analyzing any movement that causes pain, and ruling out other possible conditions.

Your physical therapist may analyze your walking and running patterns. They may test the strength of your hip and thigh muscles to find out if weakness is contributing to your pain. Medical imaging, such as an X-ray or MRI, is not helpful in diagnosing PFP. However, your physical therapist may consult with an orthopedic physician who may order imaging to rule out other conditions.

How Can a Physical Therapist Help?

If PFP is diagnosed, your physical therapist will develop an exercise and rehabilitation program just for you. Your program may include:

Strengthening exercises. Your physical therapist will teach you exercises to help strengthen the muscles around the hip and the knee itself. Research shows that this type of exercise therapy is the best approach to managing PFP.

Taping. Your physical therapist may teach you how to apply tape to your knee, which may improve your ability to perform exercises that would normally be painful. However, taping alone will not resolve PFP. It must only be used along with your exercise program.

Shoe inserts. Your physical therapist may recommend shoe inserts to help reduce your pain when exercising. But inserts alone, like taping, will not treat PFP. Your physical therapist will design an exercise program to fit your specific needs and goals.

Coordination training. Based on your activity level, your physical therapist may help retrain your hip and knee movement patterns to reduce your knee pain.

This type of training is effective for athletes, in particular, and may focus on movements like:

  • Stair climbing.
  • Squatting.
  • Running and jumping.

Cross-training guidance. Physical therapists help athletes and active people perform different movements (cross-training). This helps them stay active until they can return to a favorite activity.

Return to full activity. Your physical therapist will help guide a gradual return to your favorite activities, such as running and jumping, and will teach you good overall exercise habits to help maximize the health of your knee.

Treatments That Do Not Work for PFP

While these can be appropriate for the treatment of other injuries or conditions, the following do not work for PFP:

Quick fixes. “Passive” treatments like dry needling, ultrasound, laser, or electrical stimulation are not helpful for people with PFP. The most effective treatment for PFP is an exercise program that targets the hip and knee muscles.

Rest. If you are experiencing PFP, it is important to understand that rest only helps temporarily. Your pain will likely return when you go back to your normal activity. Rest is not helpful in the long term. A movement program guided by your physical therapist is your best treatment option.

Can This Injury or Condition Be Prevented?

Current research shows that a person’s age, height, body weight, or foot alignment may not contribute to the risk of developing PFP at all. A knock-kneed posture also does not increase the risk of developing PFP.

However, a few preventive measures can be effective. To help reduce your risk of developing PFP:

  • Keep your thigh muscles strong.
  • Maintain good exercise habits.
  • Avoid rapid spikes in activity levels.
  • Participate in a variety of sports, rather than just repeating the same movements again and again.
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