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Patellofemoral Pain Syndrome

People presenting with Patellofemoral Pain Syndrome (PFPS) most commonly experience vague pain around the patella (kneecap) especially during knee flexion (bending) activities. These may include sitting for a long period of time, kneeling, squatting, walking up/down steps and running. 

It is most commonly reported in people aged 12-17 years however it can occur in other age groups too, and has been found more prevalent among females.

What increases my risk of developing Patellofemoral Pain Syndrome?

There are a range of physical and biomechanical factors that may put you at risk of developing PFPS, which include:

  • Problems around the kneecap (mobility of the kneecap etc)
  • Below the kneecap (ankle mobility, calf strength etc)
  • Above the kneecap (hip strength, trunk endurance, hamstring and quadriceps flexibility etc)

There are also other factors, other than physical and biomechanical, that can influence a person’s presentation, therefore consideration of the whole person rather than just the injury is required during your assessment and management.

Your physiotherapist will perform a thorough assessment to identify which factors are most relevant to you and those that need to be addressed during management.

The assessment with a physiotherapist will involve a range of questions and tests to help confirm the diagnosis, and to also determine what factors led to it developing. Treatment is often needed to target these factors to ensure the problem doesn’t recur in the future.

Do I need a scan to confirm diagnosis?

Simple answer, no.

In most people, a thorough assessment by your physiotherapist is usually enough to make a diagnosis and to determine the best treatment, so investigations like x-rays and scans are not needed to get you started on treatment.

However, if your physiotherapy assessment determines that there may be other knee joint injuries, or if you don’t improve despite a thorough non-surgical treatment program, it is only then that x-rays or scans could be necessary.

This highlights that tissue damage does not always equal pain and other factors need to be considered in order to achieve the best outcome for management.  


A broad management approach is recommended as a range of factors can contribute to a person’s presentation.

During the initial stages of recovery, the Physiotherapist will provide advice on how to modify your daily and/or sporting activities. For example, it has been found that increasing cadence (number of steps taken per minute) by 10% can reduce load over the kneecap by 14%, so this can be an effective way to reduce pain.  They will also review the type and number of activities you perform during a typical day/week and monitor your symptom response to guide decisions when managing your total load and recovery.

Hands-on treatment may be performed to ease muscle tension around hips, buttock, thigh and lower leg areas. Specific joint mobilisations can be used to improve kneecap mobility if indicated by clinical assessment. In addition, taping may be used to reduce load over the kneecap area during the initial stages.

Most importantly your Physiotherapist will help guide you through an exercise program to best manage your condition in building your capacity to meet your training needs.

In people who present with increased pain related to PFPS good outcomes have been found from exercise programs targeting higher muscle groups areas such as the trunk, abdominal, hip and buttock areas to reduce pain and improve function. A person will also perform knee strengthening exercises in particular targeting the quadriceps muscles. 

During the middle and late stage of management your Physiotherapist will incorporate more functional movements such as squats, lunges and steps with specific parameters to monitor your symptom response to these activities.

Some examples of these exercises include:

patellofemoral pain exercise 1

patellofemoral pain exercise 2

patellofemoral pain exercise 3
Need help with Patellofemoral Pain Syndrome?

If you’d like to see Sam Campagnale or one of our other Physiotherapists for this issue, you can:

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