Patellofemoral Knee Pain / how-we-help / manage-patellofem-knee-pain

Patellofemoral Knee Pain

Knee pain is one of the most common injuries faced by runners and needs to be managed quickly and correctly to let you hit the roads or trails again as soon as possible.

Due to the repetitive nature of running, poor biomechanics (the way you move) can increase your risk of pain and injury.

One of the most common types of problems that may develop with running is knee pain and by far and away the most common cause of knee pain is Patellofemoral Pain Syndrome (PFPS).

What is Patellofemoral Knee Pain?

PFPS is a term used to describe the progressive degeneration of the joint cartilage surface of the patella (the knee-cap), accompanied by pain and inflammation of the surrounding tissues.

The patellofemoral joint is the articulation between the patella and the thigh bone (femur) at the front of your knee.  

The patella acts to mechanically increase the pull of the thigh muscles to produce knee straightening and resists knee bending when you move. It also works to concentrate the work of the large, strong thigh muscles into one point.  

The tracking of the patella within its groove on the femur (the patellofemoral joint) is very important to allow this joint to function effectively and in a pain-free manner. 

What Causes PFPS?

Maltracking of the patella causes an increase in contact pressure on the bones and is associated with pain production.

Maltracking of the patella can be caused by different reasons, the three most common are:

  1. Weak hip muscles, especially the gluteal muscles (your butt muscles), will allow the femur to rotate inwards and move toward the midline of your body. This will change the angle of pull on the patella and drag it out of its joint groove on the femur causing stress.
  2. A large hip to thigh angle (Q-angle) will also change the angle of pull of the thigh muscles on the patella, often resulting in stress on the articular tissues.
  3. Rearfoot pronation that occurs too long or at the wrong stage of the gait cycle will produce internal rotation of the lower leg. This has the effect of once again changing the alignment of the patella in it’s joint and increase joint stress.

The first step to managing the pain associated with PFPS is to find out what the cause is.

As my first boss used to say; “you can’t fix it unless you know what’s broken” and in the case of PFPS, an assessment of the way you run is really important.


If you get knee pain while you run, there is no point in someone looking at you sitting in a chair or just standing in a room.

Your running form needs to be assessed and the factors affecting the increase in the load on the knee joint need to be determined before a treatment plan can be developed.

The treatments I most commonly prescribe for treating PFPS include the following:

  • Manage pain - pain changes your gait and stops you moving normally,
  • Strengthen the hips and lower legs muscles - squats, lunges, bridge etc,
  • Change the load on the knee - add different activities, cross train,
  • Improve running form- if we want better running form, we must practice better running form with running drills, changes to running gait, better, more appropriate training practices etc, 
  • Improve foot mechanics - footwear changes, exercises to increase muscle strength, orthoses,
  • Use manual therapies to improve the health of the tissues - Ultrasound, shockwave, dry needling, foot mobilisation treatment.

Managing any running injury takes time and patience.  

With the right diagnosis and treatment from the expert team at Complete Podiatry however, you can get your knees feeling better and regain your love of the run!