Do you have pain in the front of your knee whenever you run or squat? Does it hurt even when you do simple things like walk up stairs or sit down for too long? If the answer is yes, you may very well have patellofemoral pain syndrome…
Before we start, the good news is, if you have patellofemoral pain syndrome (front/anterior knee pain), you can cure it, completely, with simple home treatment and exercises.
In this article, we are going to cover the following:
Patellofemoral pain syndrome relates to anterior (front) knee pain that is a result of issues between the patella (knee cap) and the femur. It can occur bilaterally or unilaterally (in one knee or both knees).
The pain typically comes on gradually. It is likely to increase when sitting for too long, during excessive use (i.e. walking, running, jumping), during or after weightlifting (i.e. squats) or ascending and descending stairs.
Patellofemoral pain syndrome is most common in people who regularly participate in sports, such as runners, basketball players, football players, and anyone who does vigorous athletics and training.
Patellofemoral pain syndrome can also occur in nonathletes too.
All in all, it is believed to be caused by overuse and problems with the alignment of the kneecap, among other contributing factors.
Fortunately, with simple home treatments, you can ease the pain of patellofemoral pain syndrome, and for most people, cure it completely. In this article, we are going to teach you exactly how to do that.
Other Names for Patellofemoral pain syndrome
Now, it’s important to note that “runner’s knee” is a common term used for multiple conditions of the knee - including patellofemoral pain syndrome - which we will get into after we run through the causes, risk factors, and symptoms of PFPS specifically.
Doctors are still unsure what causes patellofemoral pain syndrome, however, it is linked to the following:
Overuse: Sports that involve excessive running or jumping are most common for those with PFPS as it puts stress on the knee joint, thus causing irritation under the kneecap.
Injury: PFPS can also be caused by trauma to the kneecap. For instance, if you dislocate or fracture it.
Kneecap Alignment: Structural alignment can result in the kneecap shifting too much towards the outside or inside of the femur. This can be a structural problem at the knee level or at the feet and ankles.
Muscular Imbalances or weakness: PFPS can be a result of weak or imbalanced muscles around your knee and hip, especially the front of the thigh. These same issues with imbalances and weaknesses can also cause a problem with knee cap alignment.
Surgery: People who have had surgery on their anterior cruciate ligament (ACL), among other various knee surgeries, are at risk of patellofemoral pain.
Although PFPS can occur in anyone, there are a few risk factors for certain groups of people.
Sports: Certain sports are more likely to cause patellofemoral pain syndrome - Sports that involve a lot of running and jumping, such as track and field, basketball, football, and soccer, are the most common.
Weightlifting: Exercising with heavy weights (squats in particular) puts a lot of stress on your knees. As with running and jumping, this can also cause PFPS. Note: it’s not just weightlifters, people with labor-intensive jobs are also at risk.
Age: Patellofemoral pain syndrome is most commonly seen in young adults and adolescents. Seniors who have knee pain typically have osteoarthritis, not PFPS.
Gender: Women are two times more likely than men to develop PFPS. This is probably because women have a wider pelvic bone, so the angle of where the femur and patella meet is increased.
When first developing patellofemoral pain syndrome, the pain comes on gradually.
The pain is typically dull and aching and it is located at the front of the knee. It can also show itself behind the knee. That said, many individuals have trouble pinpointing the location of the pain.
Some people will describe the pain by signing a circle around the patella. This is known as the “circle sign”.
Another sign is called the “movie sign”, as pain arises when sitting for prolonged periods of time.
Overall, the pain from PFPS is aggravated by:
Now, some of the symptoms of PFPS may overlap with other conditions. So, let’s compare other knee problems so we can differentiate and make sure we have patellofemoral pain syndrome before treating it, as treatments vary depending on the culprit.
Patellofemoral syndrome vs Chondromalacia patella
Chondromalacia patella is occasionally used interchangeably with patellofemoral syndrome. Yet, the general consensus by doctors and health professionals is patellafemoral pain syndrome applies only to people without cartilage damage.
Patellofemoral syndrome vs Patellar tendonitis
Patellar tendinitis is different than patellafemoral pain syndrome, but both are called "runners knee". Patellar tendinitis pain is located in either the bottom edge of the kneecap or the tibial tuberosity (where the tendon attaches to the shin bone). Moreover, with patellar tendinitis, the pain typically decreases during activity because the tendon warms up.
All in all, tendinitis is an inflammation of the tendon, whereas patellofermoral pain syndrome doesn’t have to do with inflammation necessarily, it has to do with the nerves. That said, PFPS can lead to inflammation of the synovium and pain in the underlying bone if not treated or continuing activity through the pain.
Patellofemoral syndrome vs Osteoarthritis
First off, we are speaking of osteoarthritis, which is caused by mechanical wear and tear of the joint. Not rheumatoid arthritis, which is an autoimmune disease. Osteoarthritis is the most common form of arthritis, so let’s stick to that.
Osteoarthritis of the knee occurs mostly in people over 50. And while you may have early-onset osteoarthritis, if you are a young individual, it is most likely not the case.
Moreover, with osteoarthritis, you will have swelling and a feeling of warmth in the joint. Your knee will also feel stiff, especially in the morning, and you will have less mobility. If you refer back to the symptoms of PFPS, you should be able to differentiate between the two fairly easily.
Patellofemoral syndrome vs Torn meniscus
A torn meniscus is one of the most common injuries of the knee. However, it is hard to confuse with patellofemoral syndrome. A torn meniscus happens suddenly, as a result of an activity that causes you to twist or rotate your knee forcefully. After you tear your meniscus, you will feel a popping sensation. Your knee will swell and become stiff. It will be painful when twisting or rotating it, and it will be difficult to straighten your knee. It will feel like it is locked in place when you try to move it.
So, when considering all the above about patellofemoral syndrome, you can easily see the difference. PFPS develops over time, and the symptoms are much different.
Patellofemoral syndrome vs Osgood Schlatter
Osgood-Schlatter is a common inflammatory disease that occurs during growth spurts in childhood. It usually goes away when the child stops growing. Osgood-Schlatter Disease causes a painful bump under the knee. It worsens during activity and gets better with rest. It causes a “flare-up” that can last a few weeks to months. It can affect one or both knees.
Although both PFPS and OSD can occur in adolescents, the differences in symptoms are considerable, so you should be able to differentiate between the two.
Patellofemoral syndrome vs Patellar tracking disorder
Patellar Tracking Disorder (PTD) is a tracking or alignment issue with your knee, and while Patellofemoral Pain Syndrome (PFPD) can be caused by tracking issues, the two aren’t synonymous.
Patellar tracking disorder refers simply to the alignment and tracking problem, and it may or may not even cause pain. However, if it does cause pain, it will be very similar to patellofemoral pain syndrome.
All in all, if you notice that your knee is often shifting out of place in a noticeable way, then you should see a doctor.
If you want to avoid a doctor, at least for now, use the above comparisons to first get an idea of what is causing your knee pain. This will help you narrow down the reason for your knee pain.
A doctor will determine your knee pain with an X-ray if necessary.
After assessing your knee pain with the above information, if you are quite sure you have patellofemoral syndrome, you can move on to the treatment. The good thing is, our self home treatment will be safe, as the first part involves rest/RICE, and if the pain doesn’t get better, then you can’t move on to the exercise section and we recommend that you see a doctor. So, you are safe with the below patellofemoral pain syndrome treatment in any case.
Of course, if you have a meniscus tear or pain that occurred suddenly during exercise, sports or another activity, then you should surely go see a doctor straight away.
Before we begin the home treatment for patellofemoral syndrome, we’d like to answer some common and important questions people usually ask.
Can patellofemoral syndrome be cured?
With rest and proper physical therapy, whether done on your own or with a professional, you can slowly work your way back to normal and continue with your normal activities. However, for some people, it can be a chronic pain problem that needs to be dealt with on a regular basis as PFPS can be very treatment-resistant.
Can patellofemoral syndrome cause permanent damage?
Patellofemoral syndrome is not likely to cause permanent damage if managed correctly. However, if you tough it out, and work through the pain regularly, you can cause structural changes as you will be changing the way you move to compensate for the discomfort and pain. So, it’s best to treat PFPS seriously and not to “tough it out”.
Can patellofemoral syndrome get worse?
If you continue to overuse your knee(s) or work through the pain, patellofemoral syndrome can lead to other issues such as tendon inflammation and structural changes. It is recommended that you rest and recover and treat the issue before continuing regular activity to avoid this. This is not a condition that you want to "keep active" while experiencing pain.
Will patellofemoral syndrome go away?
Patellofermoral syndrome can go away on its own if you stop doing the activity that causes it, which can be hard to identify in some cases. For runners, if you stop running for a while and treat PFPS in the right manner, it should go away. For others, it will be a chronic pain issue that needs constant treatment, such as rest if it starts hurting, knee exercises, and knee taping/bracing/sleeves.
How long patellofemoral syndrome last?
Typically it can last for weeks and even months. With proper treatment, around 90% of people suffering from patellofemoral syndrome can become pain-free. Use our treatment method below to achieve a pain-free knee!
Does patellofemoral syndrome affect one or both knees?
Patellofemoral syndrome can affect one or both knees.
How painful is patellofemoral syndrome?
This depends on your pain tolerance. The pain is usually aching and dull and manageable. However, if you continue to overuse your knees, it can become quite painful and even debilitating.
Can patellofemoral syndrome cause hip pain?
It is not likely to cause hip pain, unless you are compensating your movements due to knee pain, which then causes hip pain.
That said, dysfunction at the hip may be your cause or a contributing factor in PFPS! The muscles around your hip may not be keeping your kneecap properly aligned. You also may have too much rotation in your hip while running. So, it would be advantageous to strengthen your hip muscles and work on coordination and postural improvements if you have patellofemoral pain syndrome.
Can patellofemoral syndrome cause arthritis?
In the long run, any activity that you do that puts a lot of wear and tear on your joint can cause osteoarthritis (not rheumatoid arthritis as that is an autoimmune deficiency). If you are young, this is not something you should be concerned with. Take the steps to fix your patellofemoral syndrome first, and be sure to treat your knees well, that way you can avoid arthritis.
Can patellofemoral syndrome cause back pain?
As with hip pain, you can have back pain with a bad knee if you are changing and compensating the way you move. Your body has a kinetic chain, from your ankles up to the top of your spine. For example, if you change the way you walk/run due to knee pain, you are affecting all the joints from your ankle to your knee to your hips and back. Thus, this change can cause pain in any of these joints as your body is not used to the altered walking/running pattern. So, you must treat your knee pain rather than compensate for it by chaining the way you move.
Now, that we’ve diagnosed our knee pain as Patellofemoral Pain Syndrome, let’s go over the steps to recover and treat patellofemoral pain at home. The following steps should help you improve and heal PFPS so you can get back to your normal activities ASAP.
First, the worst therapy for patellofemoral pain is “stay active”. While this may be the case for some issues in our body, it is not the case with PFPS.
So, the first thing we must do if we have knee pain that goes beyond just a rare, fleeting incident, is rest.
REST - Stay off your knee until the pain goes away. This means you should avoid putting weight on the painful knee and refrain from instances or activities that cause you knee pain. This includes sitting with your knees bent for long periods of time, walking, exercising and sports.
ICE - Ice your knee with an ice pack or put ice in a bag. Be sure to wrap the ice pack or bag of ice in a towel. Note: Ice your knee for 20 minutes at a time. You can do this spaced out evenly for 4 to 8 times a day. It’s important to not put ice directly on your skin and also to not go over 20 minutes as, believe it or not, you can give yourself frostbite if not.
COMPRESSION - You can use an elastic bandage or knee brace for this. You will want it to be tight, but not overly tight. The goal of compression is to hold your knee to the shape and size it is supposed to be, and it helps alleviate any pain and swelling.
ELEVATION - Try to keep your knee above your heart level for as often as you can. This will also help with pain and swelling.
Medicine: During this time it is also advisable to take a nonsteroidal anti-inflammatory OTC drug like ibuprofen or naproxen for the pain.
Foods: During RICE, eat specific kinds of anti-inflammatory food, such as broccoli, spinach, and tomato, green tea, olive oil, pineapple, salmon, berries, whole grains, oily fish, and walnuts.
How long does it take to heal patellofemoral syndrome? Recovery Time:
All in all, RICE is a very effective method for treating knee and joint pain when done within 72 hours of significant knee pain. Pretty much everyone knows RICE, but not everyone applies it to their painful joint problems. RICE should be done for a few days, especially the “rest” portion, and then your pain should be gone.
If your pain is still persisting after 3 days, it is time to see a doctor.
If your pain is gone, it is time to move on to the next step, exercises for patellofemoral syndrome knee pain.
When your pain stops, the best patellofemoral knee pain exercises to start with won’t be very strenuous. You don’t want to just jump right back into your normal workouts/exercises.
The goal of these exercises is to stretch and strengthen the muscles that attach to the muscles that function on the knee. These exercises can also help reduce any lingering pain.
What muscles should I strengthen for patellofemoral syndrome?
You will want to strengthen your knee muscles (the ones that act on the knee), quadriceps, hamstrings, glutes, and hip muscles. We will show you the best strengthening exercises to start with below. These will be strengthening exercises that will not put your knee at risk of PFPS returning.
Note: The exercises for the knee are considered stabilization exercises. What they do is strengthen the muscles that support your knee. There will also be knee extension exercises to strengthen the knee.
What muscles should I stretch for patellofemoral pain syndrome?
You are going to want to stretch your quads, iliotibial tract (IT Band), hamstrings, calves, hips, glutes, and lateral retinaculum (fibrous tissue on the outer side of the kneecap).
Remember, for both strengthening and stretching exercises, your quadriceps and hamstrings are groups of muscles, so we need to do multiple exercises for each to target them specifically. The same goes for your calves, hips and glutes.
We are going to list off the best exercises to strengthen your knee so you can prevent future patellofemoral pain. We will explain how to do each exercise and the muscles that they target.
Exercise 1: Side-lying leg lift:
Tip: If you hold the top position for a long time, you will be training isometrically, which is great for strengthening the muscles.
Muscles worked: Abductor muscles of the hips, inner thighs, glutes, hamstrings, and obliques.
Exercise 2: Quad sets:
Increase difficulty by placing a folded towel under your working knee. It will require you to press and squeeze harder.
This is an isometric exercise, so it is going to build up strength in your quads.
Muscles worked: Quadriceps
Exercise 3: Straight leg raise:
This is an isometric exercise.
Muscles worked: Quadriceps
Exercise 4: Standing ham curl:
If you want a harder variation of the ham curl, try a lying ham curl with a towel. You lay flat on your back with your heels under a towel and then slide your feet towards your glutes so that your legs are at 90 degrees. You will need a smooth surface for this one so the towel can slide easier.
Muscles worked: Hamstrings and glutes
Exercise 5: Wall squat holds:
This is an isometric exercise.
Muscled worked: Quads and glutes
Exercise 6: Glute Bridge
This is an isometric and concentric/eccentric exercise.
Muscles Worked: Glutes, hamstrings and core.
Exercise 7: Clam exercise:
Muscles worked: Outer hip and glutes
Exercise 8: Adductor squeeze:
This is another isometric exercise (as you are holding the tension to create force rather than moving to create the force).
Muscles worked: Adductor muscles of your hips
How many sets?
Do these exercises for 3 sets. If the exercise focuses on one leg, then do both sides! Even if only one knee hurts. This will make sure you don’t create any imbalances, and it can help fix any too.
How often can you do these exercises?
You can do these every day or every other day as they are not taxing on your body. Do these exercises for 4 weeks, along with the below knee exercise and lower body stretches and you should be ready to return to your normal activity in no time!
The following exercises are fantastic stabilization and strengthening exercises for curing and preventing patellofemoral pain
Exercise #1 - TERMINAL KNEE EXTENSION
Exercise #2 - LYING HIP EXTENSION
Exercise #3 - FRONT LEG EXTENSION
Exercise #4 - LYING KNEE EXTENSION
Exercise #5 - LYING GLUTE EXTENSION
Exercise #6 - STORK STANCE TKE
**Buy a set of high quality resistance bands**
Calf stretches will help to prevent tight muscles and patellofemoral pain. In many cases, tight muscles around the knees and hips lead to knee pain, so let’s get ahead of this issue by making sure we are properly stretched (yet not too stretched/laxed).
Exercise 1: Standing Calf Stretch
This is the first time you are seeing a calf exercise in our home treatment for patellofemoral pain syndrome.
Stretching the calves is very helpful for reducing tension related to patellofemoral syndrome.
There are various ways to stretch your calf, so give other variations of calf stretches a go too. That way you can hit all the muscles in your calves.
Exercise 2: Standing Hamstring stretch
There are two ways to easily stretch your hamstrings while standing.
For those who are less flexible, simply put one leg forward and keep it straight, and have a slight bend in your knee in the other leg. Then lean forward, but don’t arch your back.
For a deeper stretch, place one leg up on something like a bench. Keep that leg straight, as well as your leg that’s on the ground. Then lean forward with your hands placed on your hips.
Exercise 3: Quadricep stretch
Everyone knows this stretch. The key is to make sure you are doing it correctly. Your knee should align with your hips, or even slightly behind even with your hips, and you should be standing straight up. If you have trouble balancing, hold on to something.
Note: This stretch targets your quads AND your lateral retinaculum.
Exercise 4: Iliotibial band stretch (seated)
Sit on the floor with one leg bent at 90 degrees and your foot flat to the ground and your opposite leg fully extended forward. The leg at 90 degrees should be crossed over your extended leg right next to your knee.
Rotate your trunk towards the opposite way of your crossed leg. Use your elbow to gently push your crossed leg, as to get a deeper stretch.
Exercise 5: Iliotibial band stretch (standing)
Cross one leg in front of the other leg while keeping your feet together or a few inches apart, then lean in the opposite direction from the front leg.
Note: A tight IT Band is commonly the cause for knee pain, so we gave you two IT band stretches to prevent patellofemoral pain syndrome from happening again. These two IT band stretches will also target your piriformis muscle and your outer hips.
Exercise 6: Knee to chest stretch
Lie down on the floor with both legs extended forward then bring one leg’s knee up to your chest and pull it using your hands to get a deeper stretch.
This patellofemoral pain syndrome stretch targets your glutes, hamstrings, hips, and lower back.
Exercise 7: Figure four stretch
Lie on your back and cross your foot over your opposite leg’s quad. Hold the underside of your crossed leg and gently pull it toward your chest. When you feel a comfortable stretch, hold there.
This patellofemoral pain syndrome stretch targets your glutes, hips, hamstrings, and lower back
Exercise 8: Reclining angle bound pose
This is a stretch taken from Yoga. It is a great one to end your stretching routine as it can be relaxing. Simply lay in this position and let gravity do its work. For the other stretches, you are going to hold them for 15 to 30 seconds and do a couple sets, but for this one, you can go as long as you want really. 30 seconds to 2 minutes or so is good.
Muscles stretched: Inner thighs, hips, and groin
How long should I hold these patellofemoral pain syndrome stretches and how many time should I do them?
Except for the last one, you should hold these stretches for 15 to 30 seconds on each leg. If 15 seconds is hard, start there and work your way up over time.
Do 2-3 sets for each.
How often should I do these stretches?
These are good to do a few times a week. Say every other day or every couple of days.
Even after your patellofemoral pain is far in the past, you should continue doing these stretches weekly as they are beneficial for more than just patellofemoral pain syndrome, plus they will help prevent it from happening again!
Now you are ready to get back to your normal activities, which includes taxing workouts, running, and everything else you love to do.
However, there are a few things you should avoid and things you should do to prevent patellofemoral pain syndrome from coming back!
Here are some tips to following once you are back to your normal routine.
These are bad exercises for people with a history of patellofemoral pain syndrome:
While you can still do these if you so please, just pay attention to how your knee feels and make sure you are warmed up for them! If you feel pain, stop immediately.
We all know squats are the king of leg exercises, but you don’t need to go deep for them to be effective!
Can I run with a history of patellofemoral syndrome?
Absolutely! If your knee is back to feeling good, go for it. But there are two things you should do.
If you feel misalignment or muscle imbalances are a cause of your PFPS, then wear a knee brace or tape your knee during strenuous activity that involves your knee. This can help prevent it from happening again.
If you are feeling pain again, but it’s not too bad. Try heat and cold therapy after a workout or a run. Then, take a rest for a couple of days.
If you are overweight, losing some pounds will make a big difference to the pressure on your knees.
Focus on high reward low-risk exercises that strengthen your quads, hamstrings and glutes. Do unilateral exercises as well, as to work on muscle imbalances and improve balance and stabilization.
As with strengthening your muscles, continue stretching them. Just make sure you don’t overstretch, as you don’t want to be hyperflexible. You just want to have normalcy in your muscles. Put simply, don’t overdo it.
Unfortunately, it absolutely can, and for many people it often does. However, a lot of people don’t treat their patellofemoral knee pain as seriously as they should. If you follow the above steps, you should be able to keep patellofemoral pain syndrome at bay for good.
Resistance bands are not just great at treating and strengthening your knee if you have patellofemoral pain syndrome, they are also great for working out after you've recovered from patellofemoral pain syndrome. Why? Because they are easy on your joints! They will allow you to have an effective workout in a way that is safe on your knee joint. Moreover, bands can be used in all the same ways that free weights can - squats, presses, deadlifts, etc. So, if you want to workout and not risk patellofemoral pain syndrome coming back, bands are a great option.
We hope this article will help you cure your patellofemoral knee pain. We'd love to hear your story on how it goes. Feel free to leave a comment below or shoot us an email. We'd love to hear from you!
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