Patellofemoral Pain Syndrome

Patellofemoral pain syndrome can happen from over exercising but it's treatable and easy to prevent.

What is patellofemoral pain syndrome?

Dr. Rx

Patellofemoral pain syndrome can be stubborn and slow to improve. The good news is that it almost always eventually goes away and almost never requires surgery. Being patient is key. —Dr. Benjamin Schwartz

Patellofemoral pain syndrome is pain around your kneecap. (The kneecap is also called the patella.) Sometimes it is called “runner’s knee.” Athletes tend to get it. But anyone can get it from everyday activity that engages the knee. Climbing stairs, sitting for long periods of time, and squatting can make it worse. Often it heals after rest and ice.

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Most common symptoms

You will notice pain and swelling of the kneecap. It feels like a dull, aching pain, but you may also experience a sharp pain. It will hurt even more when using stairs or when bending down. It can feel like your leg is giving way. And some people can hear a  crunching or grinding around the kneecap.

It’s easy to confuse patellofemoral pain syndrome with other causes of knee pain. For instance,  patellar tendinitis, bursitis of the knee, patellar stress fracture, and ligament tears. The biggest difference is the others are typically more painful. And if you have an X-ray, the other issues would show tears or fractures. With patellofemoral pain, you might see some wearing of the cartilage (tissue that protects bone) under the kneecap.

Main symptoms

  • Pain in the front of the knee.
  • Swelling on and around your kneecap.
  • Bending or extending the knee is painful.
  • High-impact activity (such as running or jumping) triggers pain.

Other symptoms you may have

Cracking or popping sound when the knee is bent or extended.

Causes of patellofemoral pain syndrome

Pro Tip

The further you bend the knee, the tighter the kneecap gets pushed up against the femur (thigh) bone. When the knee is in deep flexion, the force on it can be up to 7 times higher than your body weight! It’s very common for people with patellofemoral pain syndrome to say that they recently started working out more—especially squats, lunges, and leg presses. While these are not dangerous, they can contribute to developing pain at the front of the knee. —Dr. Schwartz

Patellofemoral pain syndrome happens because of overuse of your knee. Typically it is worse with repetitive bending, running, stairs, kneeling, crouching. Women and athletes have a tendency to develop it. Especially those who do squats, run, or hike. It can also happen when you suddenly start doing high-impact activity.

It can also be caused by poor alignment between your hip and your kneecap. This can be caused by having weaker thigh muscles (quadriceps muscles), which help keep your kneecap in line.

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Treatment for patellofemoral pain syndrome

If your knee starts to hurt, follow these steps for pain relief. You should see a doctor, who can do a physical examination and refer you for physical therapy. That will help you strengthen the muscles that support the knee, like your quadriceps.

  • Rest, ice, compress (with a bandage)
  • Keep your leg elevated for several days
  • Try not to bend, squat, or sit for long periods of time.
  • Do not run, play sports, or do physical activities that make your knee hurt. It can make symptoms worse.
  • Take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to reduce swelling and pain.
  • Physical therapy for about six weeks to strengthen muscles.

How long does patellofemoral pain last?

The condition often comes on without warning. It can cause pain at the front of the knee that can range from a mild annoyance to severely limiting pain. But it often takes time to fully heal.

If pain does not go away after a few months, follow up with a doctor who specializes in bone injuries (orthopedist). They may recommend other tests like X rays or an MRI to look for other problems.

Pro Tip

It’s not entirely clear why, but many people appear to “outgrow” patellofemoral pain syndrome. Their symptoms fade and eventually disappear in early to mid-adulthood.  Ironically, while many musculoskeletal conditions become worse with age, patellofemoral pain syndrome actually tends to disappear. —Dr. Schwartz

Preventative tips

  • Always warm up and stretch well before exercising.
  • Slowly increase the intensity of your workouts. Don’t go straight from low-impact activity (or no activity) to vigorous, high-intensity activity.
  • Avoid activities that worsen knee pain, like squats, climbing stairs, or repetitive bending.
  • Change your exercise shoes when they look worn down.
  • Always warm up and stretch well before exercising.
  • Slowly increase the intensity of your workouts. Don’t go straight from low-impact activity (or no activity) to vigorous, high-intensity activity.
  • Avoid activities that worsen knee pain, like squats, climbing stairs, or repetitive bending.
  • Change your exercise shoes when they look worn down.
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