Patellofemoral Pain Syndrome Causes, Symptoms & Treatment

Overview

Patellofemoral pain is a term used to describe discomfort originating from the front of the knee, specifically around the kneecap (patella) and the muscles and soft tissues surrounding it. Because this pain occurs in the anterior, or front, portion of the knee, it is often referred to by doctors as anterior knee pain. Among athletes and active individuals, it is commonly known as “runner’s knee” since it frequently develops as a result of running or other high-impact physical activities. 

Daily movements such as climbing stairs, kneeling, squatting, or participating in sports and recreational activities can become challenging and uncomfortable when experiencing this type of knee pain. The discomfort may vary in intensity, from a mild ache during activity to a sharper, more persistent pain that interferes with exercise or routine tasks.

What causes Patellofemoral Pain Syndrome?

Several factors can contribute to patellofemoral pain. Repeated stress on the knee from high levels of activity can irritate the joint, leading to pain. Knee pain can also occur when the kneecap (patella) does not move normally within its groove. In this situation, the kneecap may shift or track to one side as the knee bends, causing poor alignment and increased stress on the knee.

• How the Injury Occurs: Patellofemoral pain develops from repeated stress, improper alignment, or overuse, causing irritation of tendons, cartilage, or soft tissues around the kneecap.
• Common Everyday Causes: Activities like prolonged sitting with bent knees, climbing stairs, carrying heavy loads, or wearing unsupportive footwear can aggravate or trigger knee pain.

These issues can contribute to specific knee conditions that cause patellofemoral pain, including:

• Patellar tendonitis: Inflammation of the tendon connecting the kneecap to the shinbone, often from repeated jumping or high-impact sports.
• Quadriceps tendonitis: Inflammation of the tendon above the kneecap due to overuse of the thigh muscles.
• Chondromalacia patella: Softening or breakdown of cartilage behind the kneecap, leading to pain during movement.
• Lateral compression syndrome: Abnormal sideways tilt of the kneecap, causing chronic stress and irritation of the knee tissues.
• Plica syndrome: Inflammation of a fold in the knee joint lining caused by overuse or injury, producing inner kneecap pain.
• Osgood-Schlatter disease: Inflammation below the kneecap in growing adolescents due to repetitive running or jumping.

Patellofemoral pain is sometimes called “runner’s knee” or “jumper’s knee” because it is common among people who play sports, such as:

• Running: Repeated knee bending and impact stress the kneecap and surrounding tissues.
• Soccer: Frequent changes in direction and sprinting place strain on the front of the knee.
• Basketball: Jumping and sudden landings can irritate tendons and cartilage around the patella.
• Skiing: Bending and twisting motions under load increase pressure on the knee joint.

Gym exercises (e.g., squats, deep knee bends): High-repetition or heavy resistance exercises stress the patellofemoral joint.

Symptoms

Patellofemoral pain syndrome usually causes a dull, aching discomfort in the front of the knee. The pain often develops gradually and can worsen with activities such as running, jumping, climbing stairs, or squatting. Long periods of sitting, like driving, may also trigger discomfort. Some people notice popping or crackling sounds accompanying the pain.

Non-operative treatment

All cases of patellofemoral pain syndrome are first managed with non-surgical methods aimed at reducing pain, inflammation, and stress on the knee. Common treatments include:

• Rest: Avoid activities that worsen knee pain to allow tissues to heal.
• Ice: Applying cold packs helps reduce swelling and relieve discomfort.
• NSAIDs (nonsteroidal anti-inflammatory medications like Aspirin): These medications help control pain and inflammation.
• Braces: Knee supports or straps can improve patella alignment and reduce stress on the joint.
• Home exercises: Gentle stretches and strengthening exercises improve flexibility and muscle balance around the knee.
• Physical therapy: A structured program guided by a therapist helps restore knee function, correct movement patterns, and prevent recurrence.

These exercises may also be recommended:

Patellofemoral Pain

Some conditions can only be treated non-operatively. These include quadriceps tendonitis, patella tendonitis, and Osgood-Schlatter disease.

Patella Tendonitis Treatment

This is the true “jumper’s knee” and can be quite debilitating. The best treatment is relative rest, which means reducing or avoiding activities that cause pain while continuing gentle movement and daily activities. NSAIDs like Aspirin or ibuprofen may be helpful, especially before activity. A brace or “patella band” can also help to minimize the symptoms.

A good therapy program that includes adequate warm-up, stretching both before and after activity, and appropriate strengthening exercises is very important for athletes with this condition. 

Quadriceps Tendonitis Treatment

Tendonitis of the quadriceps tendon is more common in older athletes. The best treatment is relative rest, which means reducing or avoiding activities that cause pain while continuing gentle movement and daily activities. NSAIDs like Aspirin or ibuprofen may be taken to reduce pain.

A good therapy program is essential, including adequate warm-up, stretching both before and after activity, and appropriate strengthening exercises. 

Osgood-Schlatter Disease Treatment

Fortunately, this condition goes away when you stop growing. However, until then,  it can be quite painful and limit your activities. The best treatment is relative rest, which means reducing or avoiding activities that cause pain while continuing gentle movement and daily activities.It is important to ice the affected area after sports. Over-the-counter NSAIDs like Aspirin or ibuprofen may be helpful, especially before activity.

A brace or “patella band” can help to minimize the symptoms. A good therapy program that includes adequate warm-up, stretching both before and after activity, and appropriate strengthening exercises is key to managing this condition.

Surgical Treatment

In rare cases, if non-operative treatments are not effective, your doctor may recommend surgery for some conditions causing patellofemoral pain. These conditions include chondromalacia patella, lateral compression syndrome, and plica syndrome. The exact surgical procedure will depend on the underlying problem.

Chondromalacia Patella Surgical Treatment

When non-operative treatments for chondromalacia patella fail, surgery may be indicated as a last resort. The surgery for this condition is an arthroscopic procedure during which your physician looks inside your knee with a small camera called an “arthroscope” and tries to smooth out the damage under the kneecap.

Lateral Compression Syndrome Surgical Treatment

When non-operative patellofemoral pain syndrome treatments for lateral compression syndrome are not successful, surgery may be offered as a last resort. During this arthroscopic operation, your orthopedist will look inside your knee with a small camera called an “arthroscope” and perform a surgical procedure in which the scar tissue that is causing the kneecap to be compressed is released. This is called a “lateral release.”

Plica Syndrome Surgical Treatment

When non-operative treatments for plica syndrome have been attempted without success, surgery may be recommended by your doctor as a last resort. This is an arthroscopic procedure during which your physician looks inside your knee using a small camera called an “arthroscope” to remove the inflamed “plica” folds that are causing pain within the kneecap.