Patello-femoral Pain Sydrome

Patello-femoral Pain Syndrome (PFPS) 

Also known as ‘Runners knee’ this condition describes pain on the front of the knee which is a result of inability of the knee cap or patella to glide smoothly through the underlying groove of the knee joint which it rests on. It is a common condition in runners as a lot of force is transmitted through the knee cap during running gait so it can become overloaded when predisposed by biomechanical issues around the knee.


Pain is felt at the front of the knee or under the knee cap and is usually made worse by running, hopping, squatting, going up and down stairs and also after long periods of sitting or having a sustained knee bend. Pain is normally onset gradually and starts as a sharp pain during the aggravating activity but can worsen to the point of being painful when walking or at rest. There isn’t usually swelling but it can be tender to touch on the inferior aspect of the patella.


Muscular imbalance and biomechanical control issues will cause the patella malalignment and mis-tracking which leads to patella-femoral pain. The inner vastus medialis oblique (VMO) and outer vastus lateralis (VL) quadriceps muscles attach to patella through the patellar tendon, and when functioning optimally should provide equal force on the patella so that it can glide through the femoral groove smoothly. In someone with patella-femoral pain, the VMO is usually weaker and will not exert as much force as the VL causing the patella to be pulled laterally creating friction.

A number of biomechanical issues may predispose malalignment including long standing tightness of structures around the knee including the ITB, quadriceps and hamstrings, weaknesses at the hip, poor foot posture and excessive pronation.

Extrinsic factors such as poor footwear, increased mileage, increased training intensity, hill running and hard training surfaces may also predispose this injury.

Prevention and Treatment

Research shows that approximately 90% of patella-femoral pain sufferers who seek physiotherapy treatment will be pain-free within 6 weeks of commencing physiotherapy guided rehabilitation.

Initially treatment for PFPS involves strategies including rest, anti-inflammatories, taping and gentle stretching to reduce pain, inflammation and loading on the knee. Once the pain has settled treatment aimed at normalising the quadriceps muscle imbalance, correcting biomechanical issues at the hip and foot and a graduated strengthening program.

Prevention of this condition is like any other running injury and includes regular stretching and foam rolling after training sessions, keeping up a core strength and conditioning routine, ensuring footwear is supportive and kept up to date and avoiding training overload.

Other Running Injury info:

  1. Plantar Fasciitis
  2. Achilles tendinopathy
  3. Patello-femoral pain syndrome
  4. Patella tendinopathy
  5. Calf Strains


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