November 9, 2022

A Physical Therapy Guide to Patellofemoral Pain

If you suffer from pain in the front of your knee, you are not alone. Patellofemoral pain (PF pain) is a common cause of pain that occurs around your patella (or kneecap), and the front of your knee. The exact number of people affected by PF pain varies; however, women are affected more often than men.1

Those with PF pain will experience their pain either at rest, with certain activities, or both. There are many factors that can contribute to the pain. While PF pain can be very frustrating to deal with, it is a condition that can be treated with CityPT physical therapy.

Patello-f-what? Let's break down the facts on patellofemoral pain. Keep reading to learn about symptoms, causes, diagnosis, conservative treatment, and prevention tips.

Table of Contents

Understanding Patellofemoral Pain

Patellofemoral pain is pain that happens at the front of the knee, and is made worse by activities that involve weight bearing through the affected leg while the knee is bent. One may experience this pain around their patella (the kneecap), or where the patella meets the femur (the thigh bone).2 PF pain is a common knee injury, and is most often diagnosed in runners. In fact, about 25% of all running related injuries are due to PF pain.3

Normally when you bend and straighten your knee, your patella moves up and down (or tracks) along your femur (the thigh bone). PF pain can happen when your patella does not track correctly along your femur. Issues with tracking of the patella can happen for a number of reasons. Below we'll discuss the most common causes of patellofemoral pain.

What are the Symptoms of Patellofemoral Pain?

The symptoms of patellofemoral pain can vary. Often times, someone with PF pain may report pain in the front of their knee, but be unable to point out the exact location of their pain. Some common symptoms of PF pain include:1

  • Pain in the front of the knee
  • Pain around, or underneath the kneecap
  • Clicking or popping around the knee
  • Feeling as though the knee is swollen, or full
  • Stiffness and pain with sitting with the knees bent
  • Pain while bearing weight with the knee bent (such as when going up and down stairs)
  • Pain with running and jumping movements

What are the Most Common Causes of Patellofemoral Pain?

There are several common causes of patellofemoral pain. These include:

  • Overuse: Those who are starting an exercise program, or who are increasing their volume or intensity of their exercise are at risk for developing PF pain.1
  • Trauma: Such as dislocation or fracture.2
  • Imbalances: In strength, mobility and/or flexibility.

Common imbalances and structural characteristics found in those with PF include:1

  • Poor patellar tracking. Normally, the patella tracks along the femur as the knee bends and straightens. Pain can occur when the patellar does not move along the femur as it should.
  • Decreased strength at the hip muscles.
  • Decreased quadricep (muscles at the front of the thigh) strength.
  • Decreased hamstring (muscles at the back of the thigh) flexibility.
  • Over pronation of the foot.

How is Patellofemoral Pain Diagnosed?

Patellofemoral pain is a syndrome. Diagnosis of a syndrome is difficult because there is no single test that can diagnose a syndrome.2 A healthcare provider such as a physician, nurse practitioner, physician's assistant, or CityPT physical therapist can help to determine if your knee pain is patellofemoral pain (or from some other knee problem.

To help make this determination, they may examine the following:

  • Patellar position
  • Patellar tracking
  • Muscle flexibility
  • Muscle strength
  • Movement patterns

What to Expect from Physical Therapy

Conservative care, particularly physical therapy, is the first line of treatment in those with PF pain. A physical therapist can help to identify the cause of your PF pain. Treating some of the imbalances in strength, mobility and flexibility can help to decrease PF pain.4

How CityPT can help

When working with a CityPT physical therapist, you can expect the following.

  • A subjective evaluation and comprehensive interview
  • An in-depth discussion of your goals, and activities that you would like to return to
  • A physical examination done online or in person
  • Assessment of your static posture, and movement patterns
  • A treatment plan to reach your goals

What if Conservative Treatment Doesn't Work?

Many of those with PF pain will get better with conservative care. In fact, conservative care may be the most effective treatment for PF pain. If conservative care, including physical therapy, does not help, surgery may be an option. Some possible surgical procedures may include:2

  • Release of the lateral retinaculum: Where the tissues along the outer edge of the patella are cut to allow for better patellar mobility/tracking.
  • Articular cartilage procedures: This may include cleaning up any defects in the bone surface which may be causing the patellar to not track normally.
  • Realignment of the tibial tubercle: This is a more complicated procedure that involves moving the tibial tubercle (place where that patellar tendon attaches to the tibia in the lower leg) to improve patellar tracking.

How Do I Prevent Patellofemoral Pain?

If you think that you may be at risk for having PF pain, there are actions you can take to make sure that you stay pain free. Some things that you can do to prevent PF pain include:

  • Increasing your activity level at a reasonable rate
  • Maintaining adequate strength at your hip and knee
  • Maintaining adequate flexibility at your knee and ankle
  • Working with a coach, trainer, or CityPT clinician to ensure that you are using good movement patterns
  • Practicing healthy habits (such as enough sleep and good nutrition) to reduce your body's overall inflammatory load and boost tissue health

Is It Time to Seek Treatment?

You do not have to let patellofemoral pain leave you on the sidelines. If you suspect that you have PF pain, CityPT is here to help. Working with a CityPT physical therapist can help you to identify the underlying cause of your pain. Additionally, they can work with you to develop a treatment plan to help decrease your pain and get you back on track.

Book an appointment with a CityPT specialist to get started.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.



  1. Peterson W, Ellermann A, Gosele-Koppenburg A, et. al. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2014; 22(10): 2264-2274. 2 3 4

  2. Gaitonde DY, Ericksen A, Robbins RC. Patellofemoral Pain Syndrome. Am Fam Physician. 2019; 99(2): 88-94. 2 3 4

  3. Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Factors associated with patellorfemoral pain syndrome: a systematic review. Br J Sports Med. 2013; 47:193-206.

  4. Alba-Martin P, Gallego-Izquierdo T, Plaza-Manzano G, et.al. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review. J Physician Ther Sci. 2015; 27(7) 23-87-2390.

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