Patellofemoral Pain Syndrome
What is patellofemoral pain syndrome?
Patellofemoral pain syndrome (PFPS) is one of the most common knee complaints seen in physiotherapy — and one of the most frequently misunderstood. It describes pain at the front of the knee, around or behind the kneecap (patella), that typically worsens with activities that load the knee in a bent position: running, squatting, going up and down stairs, sitting for long periods, or kneeling. It is sometimes called runner's knee, though it is far from exclusive to runners.
The pain arises from the patellofemoral joint — the articulation between the kneecap and the groove it sits in on the femur (thigh bone). When the patella doesn't track smoothly through this groove during movement, the result is abnormal pressure distribution across the joint surface, which over time produces the characteristic aching pain at the front of the knee.
PFPS is particularly common in younger, active populations — especially teenage girls and female runners — but it is also seen frequently in cyclists, hikers, gym-goers returning to training, and people who spend long periods sitting at a desk. It can occur in one knee or both.
What causes it?
PFPS is rarely caused by a single factor. It typically develops from a combination of training load changes, muscle weakness or imbalance, and movement pattern issues that collectively place more stress on the patellofemoral joint than it can comfortably manage.
The most clinically significant contributors are weakness or delayed activation of the hip abductors and external rotators — particularly the gluteal muscles — which causes the femur to rotate inward under the patella during weight-bearing activities, altering the forces across the joint. Weakness or inhibition of the vastus medialis oblique (VMO), the teardrop-shaped inner quadriceps muscle, affects the patella's ability to track correctly through the groove.
Foot pronation (flat feet) can contribute by increasing tibial internal rotation, and iliotibial band syndrome is a frequent co-existing condition that adds lateral tightness to the mix. A rapid increase in training load is often the precipitating factor that tips an already-stressed system into symptomatic territory.
For some patients, particularly those with knee hypermobility or patellofemoral hypermobility, the patella sits in a shallower groove or has greater inherent mobility, which makes the neuromuscular control demands even more significant.
How is it diagnosed?
Diagnosis of PFPS is primarily clinical — a physiotherapist can usually make a confident diagnosis from your history and a physical assessment. Key findings include pain reproduced with a sustained squat, tenderness along the medial or lateral patellar borders, and pain provoked by the Clarke's sign test (compressing the patella against the femur). The Australian Physiotherapy Association recommends a thorough assessment of hip and foot mechanics alongside the knee, as these are frequently the primary drivers of symptoms rather than the knee itself.
Imaging is not routinely required and does not change management in most cases. X-ray or MRI may be used to rule out other conditions such as chondromalacia patella — where the cartilage behind the kneecap is damaged — or a patellar tendinopathy if the pain is more localised to the tendon below the kneecap. Eliane Machado's doctoral research at the University of Queensland and the Federal University of São Carlos focused specifically on patellofemoral biomechanics, making her an excellent choice for complex or persistent presentations of this condition.
How can physiotherapy help?
The evidence for physiotherapy in PFPS is strong. A well-designed program addressing both local and proximal (hip and trunk) contributing factors consistently outperforms isolated quadriceps strengthening or passive treatments alone.
At Articulate, our approach to PFPS begins with a thorough assessment to understand which factors are most relevant for your particular presentation. Treatment typically involves targeted hip strengthening — particularly gluteal and hip external rotator work — quadriceps retraining with an emphasis on VMO activation, movement pattern retraining for activities like squats, steps and running gait if relevant, and load management advice to allow training to continue at a modified level where possible.
Patellar taping is a well-supported short-term intervention for pain relief during rehabilitation — it works by altering the patellar position and reducing the irritation on sensitive tissue while the underlying strength and movement changes take effect. Real time ultrasound can assist in retraining VMO activation in patients who struggle to feel the muscle working with conventional feedback.
Clinical Pilates integrates naturally into PFPS rehabilitation, providing a controlled environment for progressive hip and quadriceps strengthening that can be load-modified to keep the knee comfortable while building capacity. Foot orthoses may be considered if pronation is a significant contributing factor.
For runners, cyclists and other athletes, return to full training is guided by objective strength benchmarks rather than just symptoms — pain relief alone is not sufficient evidence that the underlying issues have been resolved. Without addressing the root causes, recurrence is common, which is why a comprehensive approach matters.
Our physiotherapists Emma Cameron, Bethany Kippen and Eliane Machado all have extensive experience treating patellofemoral pain across a range of patient groups and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Patellofemoral pain syndrome (PFPS) is one of the most common knee complaints seen in physiotherapy — and one of the most frequently misunderstood. It describes pain at the front of the knee, around or behind the kneecap (patella), that typically worsens with activities that load the knee in a bent position: running, squatting, going up and down stairs, sitting for long periods, or kneeling. It is sometimes called runner's knee, though it is far from exclusive to runners.
The pain arises from the patellofemoral joint — the articulation between the kneecap and the groove it sits in on the femur (thigh bone). When the patella doesn't track smoothly through this groove during movement, the result is abnormal pressure distribution across the joint surface, which over time produces the characteristic aching pain at the front of the knee.
PFPS is particularly common in younger, active populations — especially teenage girls and female runners — but it is also seen frequently in cyclists, hikers, gym-goers returning to training, and people who spend long periods sitting at a desk. It can occur in one knee or both.
What causes it?
PFPS is rarely caused by a single factor. It typically develops from a combination of training load changes, muscle weakness or imbalance, and movement pattern issues that collectively place more stress on the patellofemoral joint than it can comfortably manage.
The most clinically significant contributors are weakness or delayed activation of the hip abductors and external rotators — particularly the gluteal muscles — which causes the femur to rotate inward under the patella during weight-bearing activities, altering the forces across the joint. Weakness or inhibition of the vastus medialis oblique (VMO), the teardrop-shaped inner quadriceps muscle, affects the patella's ability to track correctly through the groove.
Foot pronation (flat feet) can contribute by increasing tibial internal rotation, and iliotibial band syndrome is a frequent co-existing condition that adds lateral tightness to the mix. A rapid increase in training load is often the precipitating factor that tips an already-stressed system into symptomatic territory.
For some patients, particularly those with knee hypermobility or patellofemoral hypermobility, the patella sits in a shallower groove or has greater inherent mobility, which makes the neuromuscular control demands even more significant.
How is it diagnosed?
Diagnosis of PFPS is primarily clinical — a physiotherapist can usually make a confident diagnosis from your history and a physical assessment. Key findings include pain reproduced with a sustained squat, tenderness along the medial or lateral patellar borders, and pain provoked by the Clarke's sign test (compressing the patella against the femur). The Australian Physiotherapy Association recommends a thorough assessment of hip and foot mechanics alongside the knee, as these are frequently the primary drivers of symptoms rather than the knee itself.
Imaging is not routinely required and does not change management in most cases. X-ray or MRI may be used to rule out other conditions such as chondromalacia patella — where the cartilage behind the kneecap is damaged — or a patellar tendinopathy if the pain is more localised to the tendon below the kneecap. Eliane Machado's doctoral research at the University of Queensland and the Federal University of São Carlos focused specifically on patellofemoral biomechanics, making her an excellent choice for complex or persistent presentations of this condition.
How can physiotherapy help?
The evidence for physiotherapy in PFPS is strong. A well-designed program addressing both local and proximal (hip and trunk) contributing factors consistently outperforms isolated quadriceps strengthening or passive treatments alone.
At Articulate, our approach to PFPS begins with a thorough assessment to understand which factors are most relevant for your particular presentation. Treatment typically involves targeted hip strengthening — particularly gluteal and hip external rotator work — quadriceps retraining with an emphasis on VMO activation, movement pattern retraining for activities like squats, steps and running gait if relevant, and load management advice to allow training to continue at a modified level where possible.
Patellar taping is a well-supported short-term intervention for pain relief during rehabilitation — it works by altering the patellar position and reducing the irritation on sensitive tissue while the underlying strength and movement changes take effect. Real time ultrasound can assist in retraining VMO activation in patients who struggle to feel the muscle working with conventional feedback.
Clinical Pilates integrates naturally into PFPS rehabilitation, providing a controlled environment for progressive hip and quadriceps strengthening that can be load-modified to keep the knee comfortable while building capacity. Foot orthoses may be considered if pronation is a significant contributing factor.
For runners, cyclists and other athletes, return to full training is guided by objective strength benchmarks rather than just symptoms — pain relief alone is not sufficient evidence that the underlying issues have been resolved. Without addressing the root causes, recurrence is common, which is why a comprehensive approach matters.
Our physiotherapists Emma Cameron, Bethany Kippen and Eliane Machado all have extensive experience treating patellofemoral pain across a range of patient groups and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
