Patellofemoral Pain Syndrome: What It Is and How to Treat It

Hearing that you have “patellofemoral pain syndrome” may sound like an ominous diagnosis, but don’t let the name scare you. “Patellofemoral pain syndrome is a fancy medical term that just means you have pain in the front of your knee,” says Samantha Stewart, PT, DPT, a physical therapist at Hinge Health.

And remember: Pain is simply the body's way of communicating with you. You just need to figure out what message it’s trying to send. Then, you can take steps to treat this common form of knee pain. 

Read on to learn more about patellofemoral pain syndrome, what causes it, and what you can do to feel better, including with exercises from our Hinge Health physical therapists.

What Is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome, sometimes referred to as anterior knee pain, is an irritation of the kneecap joint, the area where the femur bone in your thigh connects with the patella bone in your knee.

Patellofemoral pain syndrome is often referred to as “runner’s knee” because it’s common in people who do activities involving running, but you don’t have to be a runner to develop it. In fact, sometimes patellofemoral pain syndrome is also called “moviegoer’s knee” because you can experience this form of knee pain when you’re sitting for long periods, like in a movie theater. These two extremes highlight how broad and general this type of knee pain can be.

And just because it has the nickname “runner’s knee” that doesn’t mean that cardio activities are causing the problem or that you should stop doing them. In fact, movement is an integral part of treating patellofemoral pain syndrome.

Patellofemoral Pain Syndrome: A Hinge Health Perspective

Whether you’ve been diagnosed with patellofemoral pain syndrome or suspect that you have it, there’s no reason to feel like you’re damaged or that there’s something wrong with you. “I encourage people to take a step back from medical terminology,” says Dr. Stewart. “Doctors have to diagnose and code everything so they can chart it and track it, but instead of worrying about diagnostics, you should focus on easing pain and regaining function.”

It can also be helpful to view pain as a reminder to take care of your knees. “We use our knees for so much—walking, going up and down stairs, bending, and running,” says Dr. Stewart. “They’re pivotal to most movements we do, so pain can be a reminder that we need to protect them.”

Movement is the best way to take care of your knees and reduce pain. “Anytime you're moving your knees, you're self-lubricating them,” says Dr. Stewart. “Movement teaches the body to send fluid to knee joints so that they move more easily and more comfortably.” But it’s not just about the joints: When you're moving, you're activating muscles and making them stronger, which supports greater mobility. 

Symptoms of Patellofemoral Pain Syndrome

Patellofemoral pain syndrome usually develops gradually. When it does, you may notice one or more of these symptoms:

• A dull, aching pain in the front of the kneecap, around, or behind it.

• Pain during activities in which you bend your knee, like walking, running, climbing stairs, kneeling, squatting, or getting up from a chair.

• Pain after sitting for an extended period with your knees bent.

• Pain that may worsen when walking downstairs or downhill.

• A feeling of wanting to straighten your leg due to stiffness when sitting for a long period.

• Tenderness to the touch.

• Swelling around the knee.

• A popping or rubbing feeling when you bend your knee.

Common Causes of Patellofemoral Pain Syndrome

“Patellofemoral pain syndrome is a broad term that encompasses many different factors that cause knee pain,” says Dr. Stewart. No matter what might be contributing to your knee pain, though, there’s a lot you can do to reduce or prevent it. Here are some of the most common reasons you may experience patellofemoral pain syndrome:

• Too much activity, too soon. When you do more than your body is used to, it could lead to pain. For example, if you spend all day cleaning your house or volunteering at a garden when you usually do these activities in short bursts, your knees may feel it. “You may have knee pain from frequent squatting, kneeling, or carrying things up and down stairs if you suddenly do these activities for longer than you normally would,” says Dr. Stewart. That doesn’t mean you shouldn’t challenge yourself to be more active. You simply want to increase your activity level gradually — whether you’re cleaning, gardening, or exercising — to build strength and tolerance in the knee.

• Injury. Sometimes, simply bumping your knee or experiencing other acute injuries can result in ongoing pain. An injury can cause swelling around the kneecap, which can impact how the kneecap glides and result in further irritation.

• Muscle weaknesses or imbalances. Strong, balanced muscles distribute stress more evenly, taking pressure off joints like your knees. But if even one muscle isn’t doing its job, a trickle-down effect can cause irritation like patellofemoral pain syndrome. That’s why exercising to strengthen the entire body is a crucial part of treating and preventing knee pain.

• Foot issues. Overpronating (rolling in too much) when you walk or run can increase stress on the knees and may contribute to patellofemoral pain syndrome. Everyone has slight variations in how they walk, but addressing gait issues or changing footwear can often help with overpronation if it’s contributing to your knee pain.  

• Tight muscles. Limited range of motion from tight muscles can cause changes in walking and running patterns, resulting in increased knee pain. Tight hip flexors, for example, may impact your stride and place more stress on the knee.

• Lifestyle factors. While they may not be the primary cause of patellofemoral pain syndrome, factors like stress, poor sleep, and anxiety can contribute to knee pain and worsen it.

When to See a Doctor

Exercise can help with many causes of knee pain, but some symptoms require immediate attention. If you’re experiencing any of these symptoms, talk to a doctor or physical therapist:

• Loss of function in your legs

• Your knee is giving out

• Significant knee swelling

• Radiating pain from your knee down

• Lack of improvement with exercise

• Worsening knee pain symptoms

Treatment Options for Patellofemoral Pain Syndrome

Exercise therapy is the treatment of choice for patellofemoral pain syndrome, according to the most recent consensus statement from the International Patellofemoral Research Network, which bases its recommendations on the latest evidence. And many of the treatment strategies below prioritize movement.

• Follow the P.E.A.C.E. & L.O.V.E. method. This new pain relief approach offers a more comprehensive plan than the traditional R.I.C.E. (rest, ice, compression, and elevation) method. Instead of rest, PEACE & LOVE encourages movement as you heal.

• Pace yourself. Instead of letting pain limit you from doing activities you enjoy, like playing with your kids, gardening, traveling, walking, or cycling, adjust how you’re doing them. Don’t save all of your yard work for Saturday, for example. Spread the work out over several days, instead. If you enjoy walking or cycling, gradually build up to longer distances as your knee pain improves. “The best thing you can do is push forward in a safe way rather than pause completely,” says Dr. Stewart.

• Stretch and strengthen key muscles. When your glutes, quads, hamstrings, and calves are strong, flexible, and working effectively, they reduce stress on the knees. The exercises below will target these muscles. 

• Use ice or heat. If you notice swelling, ice can help to reduce it. Heat can also provide pain relief if that feels better to you. Apply either for 10 to 20 minutes at a time.

• Take movement breaks. Sitting for prolonged periods can aggravate knee pain, so break up any long stints with some activity. If you’re taking a road trip, for instance, stop often to get out and walk around. Work a desk job? Set an hourly alarm to remind yourself to get up and move.

• Reset your movement. Paying attention to how you move can reveal ways to improve knee function and ease pain. For example, when you bend to pick things up, are you putting all your pressure on your knees? Instead, bend at your hips and squeeze your butt when you're lifting to take some of the stress off your knees. The sit to stand exercise helps reinforce better functional movement.

Exercise therapy is one of the best ways to care for your knees. These exercises, recommended by Hinge Health physical therapists, strengthen and stretch the muscles that support the knee joint to reduce pain and improve mobility.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Feel Free to Fidget

When you’re stuck in your seat and can’t get up, fidget. “Your knees don't like to be in one position for long,” says Dr. Stewart. And there’s more pressure on them when they’re bent. When it’s not possible to get up, like on a plane or in a meeting, fidgeting can help. Move around in your seat, change positions, and do exercises like the knee extensions above, which can be done while sitting. The movement will increase lubrication in the joint to ease discomfort and stiffness.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Esculier, J.F., Maggs, K., Maggs, E., and Dubois B. (2020, December). A Contemporary Approach to Patellofemoral Pain in Runners. Journal of Athletic Training. 55(12):1206–1214.doi:10.4085/1062-6050-0535.19

2. Patellofemoral pain syndrome (runner’s knee): How can you relieve pain at the front of the knee? (2020, August 13). InformedHealth.org. Institute for Quality and Efficiency in Health Care (IQWiG). https://www.ncbi.nlm.nih.gov/books/NBK561504/ 

3. Mulcahey, M.K., Hettrich, C.M., and Liechti, D. (2020, October). Patellofemoral Pain Syndrome. OrthoInfo. American Academy of Orthopaedic Surgeons.  https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/

4. Collins, N.J., Barton, C.J., van Middelkoop, M., Callaghan, M.J., Rathleff, M.S., Vicenzino, B.T., Davis, I.S., Powers, C.M., Macri, E.M., Hart, H.F., Silva, D.O., and Crossley, K.M. (2018). 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat. British Journal of Sports Medicine. 52:1170-1178. doi:10.1136/bjsports-2018-099397

5. Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The Association of Sleep and Pain: An Update and a Path Forward. The Journal of Pain, 14(12), 1539–1552. doi:10.1016/j.jpain.2013.08.007

6. Hannibal, K. E., & Bishop, M. D. (2014). Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. Physical Therapy, 94(12), 1816–1825. doi:10.2522/ptj.20130597