Patellofemoral Knee Pain

Author: Courney Erickson-Adams, MD

It’s often referred to as “runner’s knee,” since it’s a condition that athletes who participate in certain sports may develop. However, patellofemoral knee pain can also affect individuals who’ve never laced up a pair of running shoes. Here, we’ll discuss the characteristics of patellofemoral knee pain, what causes it, how it’s diagnosed, and what can be done about it.

What is patellofemoral knee pain?

Characterized by pain at the front of the knee and around the kneecap—aka the patella—this condition occurs more often than you may think. According to the American Academy of Family Physicians (AAFP), patellofemoral pain syndrome (PFPS) is “one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults younger than 60 years.” A hallmark sign of PFPS is an increase in pain in or around the front of the knee when it’s flexed during activities in which an individual bears weight—such as participating in certain sports, going down the stairs, or squatting. Sitting for long periods with the knees bent can also make it worse. 

What causes it?

Individuals who develop PFPS are often active, may be long-distance runners, and/or may have increased their activities levels too quickly. Women are twice as likely to develop PFPS and individuals who are overweight are also at increased risk.  There are a number of factors that can contribute to PFPS, including:

  • Overuse—such as bending your knees repeatedly during high-stress weight bearing activities, like lunges or sports that requires a lot of running, jumping, or abrupt changes in direction.
  • Injury—due to a direct hit to the knee, such a fall or blow to the joint.
  • Malalignment—in which the bones of the hips, legs or feet don’t line up as they should, which prevents the normally smooth movement of the kneecap and causes pain.
  • Foot problems—such as loose joints (hypermobility), fallen arches (flat feet), or overpronation (rolling of the feet inward). All of these conditions can change the way a person walks, putting additional stress on the knee.
  • Thigh muscles that are weak or out of balance—since maintaining the proper positioning of the knee cap when the knee is bent requires strong thigh muscles that aren’t too weak or too tight.
  • Chondromalacia patella—a condition in which the cartilage under the kneecap deteriorates.

How is it diagnosed and treated?

PFPS can usually be diagnosed by your doctor through a patient history and exam to help rule out other conditions that may have similar symptoms. For the same reason, additional tests may be ordered, such as x-rays, a CT scan, or an MRI.  

The most common approach to treating PFPS is through the use of conservative measures, including: 

  • Applying ice to your knees for 10-20 minutes after activities to decrease pain and inflammation and speed healing.
  • Using certain over-the-counter medications in consultation with your doctor.
  • Receiving physical therapy for evaluation of contributing factors and to improve strength and flexibility to the hips, trunk, and knees.
  • Avoiding activities that cause stress on the knees during the healing period. 

If you’d like to receive expert guidance about dealing with patellofemoral knee pain—contact us. We’d love to help.