Patellofemoral Pain Syndrome (PFPS)—often called runner’s knee—is one of the most common causes of pain around the front of the knee. It affects active individuals and non-athletes alike and can significantly interfere with running, walking, stair climbing, gym training, or even sitting for long periods.

What Is Patellofemoral Pain?

Patellofemoral pain refers to discomfort felt around or behind the patella (kneecap). It is typically aggravated by activities that load the joint, such as:

• Running
• Squatting
• Going up or down stairs
• Kneeling
• Prolonged sitting (“movie/theatre sign”)

The pain is thought to stem from increased joint stress, soft tissue irritation, altered patellar tracking, or imbalances in muscle strength and control.

Who Can Be Affected?

Patellofemoral pain affects a very wide demographic:

• Teenagers and young adults, especially females
• Recreational athletes, particularly runners and cyclists
• Older adults, due to degenerative changes
• Anyone with muscle imbalance or altered lower-limb biomechanics

Research suggests that 22–30% of the general population experience patellofemoral pain at some point.

Muscle Imbalance and Its Role in Patellofemoral Pain

Muscle imbalance is one of the key contributors to patellofemoral pain. When forces acting on the patella are uneven or poorly coordinated, the kneecap can shift laterally, increasing pressure on the joint.

1. Quadriceps Imbalance (VMO vs Vastus Lateralis)

The vastus medialis oblique (VMO) and vastus lateralis (VL) work together to guide the patella during knee extension.

• VMO is weak, delayed, or under-active
• VL is dominant, overactive, or tight

This imbalance can pull the patella laterally, increasing compression on the joint.

2. Hip Muscle Weakness

Weakness of the gluteus medius and gluteus maximus often leads to:

• Dynamic knee valgus
• Hip internal rotation
• Poor lower-limb alignment

3. Tight Lateral Structures (Including ITB)

Tightness of the iliotibial band (ITB) and lateral retinaculum can increase lateral pull on the patella, worsening tracking and pain.

How Physiotherapy Can Help

Physiotherapy is the most effective first-line treatment for patellofemoral pain.

1. Strengthening Programme

• VMO activation and quadriceps control
• Hip abductors and external rotators
• Gluteal and core stabilisers

2. Manual Therapy and Soft Tissue Techniques

• Soft tissue release (VL, quadriceps, ITB)
• Patellar mobilisation
• Trigger point release
• Stretching of tight structures

3. Movement Retraining

• Correcting squat or step-down technique
• Adjusting running gait
• Improving load distribution strategies

4. Taping or Bracing

Kinesiology taping may temporarily improve tracking and relieve pain.

5. Activity Modification and Load Management

Reducing aggravating activities while gradually reintroducing load ensures recovery.

6. Patient Education

Understanding healing times and the importance of progression improves outcomes.

Prognosis

Most people experience improvement within 6–12 weeks of structured physiotherapy. Long-term recovery is very achievable with consistency.

Conclusion

Patellofemoral pain is common but treatable. With the right physiotherapy approach—addressing muscle balance, movement patterns, and load management—you can return to the activities you enjoy.

Bibliography

1. Willy RW, Hoglund LT. Clinical Management of Patellofemoral Pain. JOSPT, 2022.
2. Crossley KM et al. Patellofemoral pain consensus statement. BJSM, 2016.
3. Smith BE et al. Incidence and prevalence of patellofemoral pain. PLoS One, 2018.
4. Collins NJ et al. Exercise therapy and load management. BJSM, 2018.
5. Lack S et al. Exercise rehabilitation effectiveness. BJSM, 2015.
6. Petersen W et al. Patellofemoral pain syndrome. Knee Surgery Sports Traumatology, 2014.