Professional Patellofemoral Pain Syndrome Treatment

While athletes may be familiar with the concept of ACL injuries, there are many different types of knee injuries that can impact people who participate in sports. Patellofemoral pain syndrome is one such example.

The patellofemoral joint (PFJ) is where the patella (knee cap) meets the femur (thigh bone). Your quadriceps muscles attach into the patella via the quad tendon, which then attaches into the tibia via the patellar tendon. 

The patella increases the moment arm of the quadriceps muscle, increasing its mechanical advantage and ability to produce force. People experiencing patellofemoral pain commonly experience symptoms when going up and down the stairs, squatting, running, jumping, or sitting for prolonged periods of time (theatre sign). 

What is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome (PFP) is characterized by diffuse pain that is felt around the knee cap. It may also be referred to as “Runner’s Knee” or “Anterior Knee Pain.” 

Patellofemoral pain is a diagnosis of exclusion, meaning that if all other common diagnoses that are associated with pain in the front of the knee are ruled-out, PFP may be provided as the diagnosis. There should be no history of trauma and swelling of the knee.

Patellofemoral Pain Syndrome Symptoms

Experienced symptoms of patellofemoral pain syndrome may include:

  • Pain around the knee cap
  • Crepitus (joint sounds such as, cracking and popping)

Crepitus is common in patients with PFP; however, it has no impact on knee pain or function. 

Patellofemoral Pain Syndrome Causes

The cause of patellofemoral pain is unknown. It was once thought that degeneration of the patellofemoral joint was the cause of PFP; however, research has shown that there is no difference in patellofemoral joint cartilage composition in individuals with PFP compared to healthy individuals. 

Patellofemoral joint malalignment was also once thought to be causative of PFP; however, that hypothesis has not held up to the scientific research. 

Causes of PFP seem to be multifactorial in nature with inability to tolerate activities requiring loaded flexion being the most provocative. In many cases, introducing a new activity to your routine or performing an activity for longer than you are used to can lead to an issue. Life stress, sleep, and nutrition are factors that can contribute to persistent PFP. 

PFP is experienced in people of all ages and demographics, ranging from adolescence to elderly and from sedentary to highly active populations. PFP is particularly noticeable in athletes who participate in sports that require running and jumping. 

Patellofemoral Pain Syndrome Treatment

Our team of professional physical therapists at Herlong Sports Physical Therapy have a track record of helping athletes and non-athletes recover from patellofemoral pain syndrome and related injuries.

During your physical therapy treatment, we will identify your specific impairments and provocative activities. The goal of physical therapy is to gradually load the patellofemoral joint at a tolerable level of symptoms. Over time, we will increase the intensity and frequency of these activities to aid the body in adapting to these exercises until the forces the knee experiences from day-to-day activity and from participating in sports are no longer high enough to cause pain. 


Your rehab will gradually progress in exercises involving increased knee flexion angles, resistance, and the degree to which the knee travels over the toe, all of which increase the amount of stress on the patellofemoral joint. The goal is to stress the components of the neuromusculoskeletal enough to elicit an adaptive response. 

Patellofemoral Pain Syndrome Exercises

Anterior step-down 

To perform this exercise: 

  1. Start on a 4 in box with your toes at the edge. 
  2. Standing on the leg that is having pain, you will slowly lower the opposite foot to the ground like you are walking down the stairs, but just tap the heel to the ground and come back up to the starting position. 

Repeat for 10 repetitions, 3 times per day. This exercise can be progressed by increasing the height of the box or by holding a weight while performing the exercise.

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