Patellofemoral Pain Syndrome (PFPS)

  • Usually caused by overuse and overload of the patellofemoral joint.

  • May also be due to muscle weakness from anatomical abnormalities (muscle imbalances)

    • Excessive overload or patella mal-tracking (over activity or knee cap not tracking well in the joint)

      • Patella mal-alignment can cause pain due to overuse and patella tracking improperly in the groove or putting excess pressure on femur (upper leg bone) vs sitting in the trochlea groove 

      • Deviations of the patella can cause muscle imbalances 

    • PFPS may also develop from knee hyperextension, lateral tibial torsion, genus valgum or varus (knocked knees or bow legged), increased Q angle, tightness in IT band (causing excessive lateral force on knee or lateral tracking), hamstrings (excessive posterior force on knee) or gastrocnemius (causes foot pronation) 

    • May develop from pes planus / pronation (flat feet) due to causing internal rotation of the tibia or femur (hip/knee rotation)

    • Foot supination also may cause PFPS due to less cushioning as the foot hits the ground - less force absorption 

    • Gluteus medius weakness (hip weakness) → causes excessive hip adduction while running therefore causing knee pain or can cause foot pronation

  • Signs/Symptoms: 

    • Pain with squatting, climbing stairs, running, sitting with knees bent, kneeling down

      • Typically present with anterior knee pain (front of the knee)

    • Pain during activity → mechanics issue

    • Pain after activity → inflammatory

    • Pain that improves with exercise → muscle length issue 

    • Pain is typically sharp in nature and is located behind the knee cap

  • If unstable such as repeated subluxations & swelling 

    • See MD 

  • May be insidious onset, traumatic or overuse