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Patellofemoral Pain Syndrome

Patellofemoral Pain (PFP) is considered a diagnosis of exclusion for anterior knee pain (pain in the front of your knee or around your kneecap).  Structurally, there is no specific tissue that is seriously damaged.  Despite its seemingly vague description, this diagnosis is commonly the answer given.  Let’s dive into what it means!

What is the patellofemoral joint:

It is where the kneecap (patella) and thigh bone (femur) meet at the front of the knee. There is a groove behind the kneecap that allows for it to glide up and down as your knee straightens and bends.


  • Pain with prolonged sitting
  • Pain with stairs
  • Pain with squatting
  • Pain with knee extension (straightening)
  • Pain with kneeling

Risk factors for Development: 

  • Female sex
  • Decreased quadriceps flexibility
  • Increased mobility of the patella (kneecap)
  • Decreased knee extension strength
  • Decreased power from the quadriceps

Common Causes 

  • Quadriceps muscle deficiency:
    • the quadriceps is the primary muscle responsible for straightening your knee
    • it also has direct attachment to the patella, helping to control how it moves as you bend and straighten your knee
  • Hip weakness 
    • Hip stability allows for you to stand on one foot without the opposite hip from dropping lower
    • Walking requires a period of single limb stance as you lift one foot in front of the other
    • If weakness exists, every time you walk your hip drops and places increased stress on the knee, leading it to bow in (a position called valgus)
  • Flexibility
    • The quadriceps, hamstrings, and gastrocnemius muscles all cross the knee joint and a loss in mobility can impact how your patella moves 
  • Excess foot pronation
    • Pronation refers to your foot “rolling in,” some amount of pronation is necessary, but too much can lead to your lower leg rotating in, causing valgus and placing increased stress on the knee joint

Why Physical Therapy, Why NOW?!

  • Personalized Care
  • Increased Strength
  • Increased Mobility
  • Reduced/Absent Pain
  • Improved Body-Awareness
  • Education regarding your condition and how to manage it

A Doctor of Physical Therapy (DPT) will evaluate your individual body structure and function, determine which of these factors AND more could be contributing to your pain experience.  While the pain or limitations you feel are at your knee, the evaluating doctor can determine where and what is causing your pain (even if it’s coming from another region, like your foot).  If the condition proves to require further medical testing, the evaluating therapist will be able to determine that and direct you accordingly.

Whenever pain is a factor, muscle groups stop working efficiently and people avoid pain provoking activities.  The result is weakness, reduced mobility, and more pain.  Waiting to get your knee evaluated only extends the time it takes to get you back to living the life you want, participating in activities you enjoy, and being able to comfortably sit, walk, run, etc.  Time is the only thing that you can’t get back.  Spend some time with our team of therapists and athletic trainers, so that you can spend more time focusing on the things and people that matter most!

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