KneeŞişli, Istanbul
Patellofemoral pain syndrome treatment
Patellofemoral pain arises from excessive pressure as the kneecap moves within its groove on the thigh bone. Anterior knee pain that increases on stairs, squatting and after prolonged sitting is the typical picture.
Also known as: Runner's knee, anterior knee pain, patellofemoral syndrome
What is it?
The kneecap glides up and down within a groove at the lower end of the thigh bone. The contact pressure between the back of the kneecap and that groove rises markedly with the angle of knee bend. Descending stairs it reaches several times body weight — which is why pain becomes obvious with these movements.
The source of the problem is often not the knee itself. Weakness in the hip muscles allows the knee to collapse inward during movement, and that collapse pushes the kneecap toward the edge of its groove. Foot and ankle mechanics are part of the same chain. Treatment of a complaint presented as 'knee pain' is therefore largely delivered through the hip.
The second decisive factor is load management. Pain frequently begins after a sudden increase in training volume: running distance raised abruptly, starting a new sport or an unaccustomed activity. Pain appears when the balance between tissue capacity and the load placed on it is disturbed.
Symptoms
- Poorly localised pain around or behind the kneecap
- Symptoms clearly worse descending stairs
- Pain after sitting with the knees bent for long periods (the theatre sign)
- Pain increased by squatting and kneeling
- Grinding or crunching sensation at the kneecap
- Pain increased walking and running downhill
- A sense of mild swelling after activity
Causes and risk factors
- Weakness in the hip abductors and external rotators
- A sudden increase in training volume
- Weakness or imbalance in the quadriceps
- The knee collapsing inward during movement (dynamic valgus)
- Problems in foot and ankle mechanics
- Habitually sitting with the knees bent for long periods
The assessment
The onset of pain and recent activity history are explored in detail; an increase in volume is the trigger in most cases. The area around the kneecap is palpated and compression tests applied. The key information, however, comes from movement analysis.
Whether the knee collapses inward during a single-leg squat and stair descent is observed. Hip abductor and external rotator strength is measured on both sides; the difference is usually clear and directly determines the programme's target. Foot mechanics and quadriceps strength are also recorded.
Course of treatment
Weeks 0–3
Adjusting the load
The volume of activity provoking pain is temporarily reduced — not stopped entirely, but brought to an acceptable level. Hip strengthening begins immediately; there is no benefit in waiting in this condition.
Weeks 3–8
Building hip strength
Gluteus medius and the external rotators are strengthened systematically. Quadriceps work is done within the pain-free range of knee angles. This is the decisive phase of treatment.
Weeks 8–14
Movement control
Single-leg squat, stair descent and landing technique are retrained. The aim is to use the strength gained during real movement; strength alone is not enough.
Maintenance
Graded return
Running and sport volume is increased by no more than about 10% per week. Hip strengthening continues twice a week; if stopped, pain returns within a few months.
How long does it take?
Clear improvement is usually seen within six to twelve weeks, with a programme of 10–16 sessions. This condition requires patience — measurable gains in hip strength take six to eight weeks and pain follows those gains. Recurrence is high where the programme is abandoned early.
When to see a doctor
The findings below fall outside the scope of physiotherapy and require medical assessment.
- Locking or true catching in the knee
- Large swelling developing rapidly after injury
- Inability to bear weight on the knee
- Fever, redness and warmth
- Pain not relieved by rest at night and steadily increasing
- A history of the kneecap dislocating
Frequently asked questions
Is the cartilage worn?
In patellofemoral pain there is usually no structural cartilage damage; the problem is pressure distribution. Even where imaging shows findings, that does not mean the pain is permanent — it usually resolves as strength and control improve.
Is it advisable to stop running?
Usually no. Rather than stopping entirely, distance and pace are adjusted. A volume where pain stays within acceptable limits is found and increased from there; this approach produces faster results than complete rest.
Why work the hip for knee pain?
Because the kneecap's position in its groove is largely determined by the position of the thigh bone, which the hip muscles control. If the hip is weak the knee collapses inward with every step and pressure rises. Research shows hip strengthening is the most effective intervention in this condition.
Do taping or a knee brace help?
They can reduce pain short term and make exercise possible, which is why they are used as temporary support. They are not a lasting solution on their own and cannot replace gains in strength.
Methods used
Related conditions
Articles on this topic
Articles covering the topic in detail: symptoms, treatment, exercise and daily life.
- Diagnosis and symptoms· 6 min readKneecap pain: what is patellofemoral pain syndrome?
- Treatment course· 6 min readTreating kneecap pain: why it starts at the hip
- Exercise· 6 min readKneecap pain exercises: sequence and progression
- Treatment decision· 6 min readWhen does front-of-knee pain require assessment?
- Daily living· 6 min readStairs, sitting and footwear in kneecap pain
The content on this page is for information only and does not replace medical diagnosis or treatment. Always consult a healthcare professional about your symptoms.
Assessment appointment
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