Keep Moving . . . Patellofemoral pain

Jeff Albertson
Jeff Albertson

By Jeff Albertson

With fall sports underway, our clinic is seeing a spike of youth athletes reporting pain in the front of the knee.
Patellofemoral Pain Syndrome (PFPS) is the most common injury seen in sports medicine centers and is frequently seen in runners and young athletes.

What is Patellofemoral Pain?
Rather than a true “diagnosis”, PFPS is a description of the pain’s location – between the femur and the patella (or knee cap). Pain may be:

  • Variable depending on activity level.
  • Worse on the stairs.
  • Worse when sitting for long periods of time with the knee bent.
  • Associated with “cracking”, “grinding” or “popping” during movement.

PFPS has many causes and can present differently depending on the combination of tissues involved. For this reason, a diagnosis of PFPS is typically associated with a “subclassification” that is better described by the pathomechanics leading to the pain.

* See our extended blog for descriptions of various causes.

How is it Diagnosed?
X-rays are typically unnecessary, as a particular set of clinical findings can confirm a diagnosis of PFPS.

What Causes It?
PFPS is a “repetitive stress syndrome” associated with poor patellar alignment, friction between the undersurface of the patella and the femur, and strain to the tissues that attach to the patella.
Contributing factors include:

  • Weakness and tightness in the muscles around the hip and knee
  • Abnormalities in lower leg alignment

PFPS in young athletes may be a result of cartilage softening under the patella, or inflammation of the surrounding soft tissues.

Alternatively, PFPS in aging athletes is more likely due to wear and tear of the cartilage under the patella.

Either way, these symptoms are treatable!

What you can do?
Patellofemoral pain commonly flares up with a sudden increase in activity – particularly activities that ‘load’ the joint excessively, such as:

  • Squatting – 7x body weight  (Deep Squatting = up to 20x body weight!)
  • Descending Stairs – 5x body weight
  • Running – 7x body weight

Any increase in these activities must be done gradually and carefully.

If you are experiencing symptoms, adhere to some basic advice:

  • Avoid prolonged sitting with the knees bent
  • Minimize stairs, squatting and other tasks that place large compressive loads across the patella.
  •  Ice the front of the knee after activity or when flared up.

While the knee is naturally resilient, once the surrounding tissues are irritated, frequent pain may limit even the simplest daily tasks.

If you are experiencing pain in the front of your knee, seek the services of a Sports Physical Therapist.

* See our blog at for much more information on PFPS including research and management strategies.

As always, please email me with any thoughts on this subject, injury-related questions or ideas and requests for future articles.

Jeff Albertson is a sports physical therapist and the Director of Physical Therapy at VASTA Performance Training and Physical Therapy. See for information on services or for more tips on remaining injury free.
Jeff and his family live in Charlotte.