Patellofemoral Pain Syndrome – A Real Pain In The Knee

Do you have pain in the front of your knee that seems to have come from nowhere? Does it hurt when you are going up or downstairs? Or if you have been sitting for too long? Well there is a fair chance that you have developed Patellofemoral Pain Syndrome (PFPS), a pain in the front of your knee, around or behind your kneecap, in the joint that articulates your patella and your femur (thigh bone). It is just as commonly found in a young, active population as it is in the sedentary, older age group. “Maltracking” or abnormal gliding of your kneecap in its groove as your knee bends is generally what triggers your pain. There are often issues in your knee, hip and ankle that can lead to this maltracking of your knee cap.

A physio assessment can help to resolve your pain straight AWAY with an assessment to see what your contributing factors are, and then directly addressing them. Most of the time with massage, mobilisations, stretching, taping and STRENGTHENING (especially of your VMO).

So, if learning about how best to manage your knee pain is of interest to you, please READ ON for a more detailed explanation on all things Patellofemoral Pain Syndrome, including tips some surprise news your knees will love!

Why am I getting this pain?

Normally, your kneecap glides up and down the femoral (also known as trochlear) groove, which is located at the end of your thigh bone, as your knee bends and straightens. As your knee is bent, pressure between your kneecap and the groove increases, as the kneecap pulls into the groove tightly. If your kneecap repeatedly does not glide normally through the groove, but “maltracks” (i.e. it travels or rubs more to one side), gradual irritation to the joint surfaces occurs and pain behind the kneecap is felt… OUCH!

PFPSImage credit: Ortho Info

Your quadriceps (thigh) muscles attach to the patella and through it to the patella tendon, which attaches to the top of your shin.

So what does it feel like I hear you say?

  • It’s often a gradual onset of pain felt behind or around the kneecap
  • Pain is felt with weight bearing activities that involve bending of the knee like squatting, lunging, kneeling, walking up and down stairs
  • Pain comes on with sitting, especially worse with low chairs, hence the term “movie goers knee”

I thought my knee was strong? Why am I getting this pain?

As mentioned above, generally the onset of pain is gradual. The condition develops slowly, often as a result of other issues in your lower limb or sudden changes in activities, causing more bending in your knee.

glutesImage credit: Get Back To Sport

Google says it’s all about quads exercises. Is that true?

Well close, “VMO” (Vastus Medialis Oblique) is that small muscle on the inside of your knee that forms part of the large muscle group quadriceps “quads”. The action of the VMO is very important in walking, running and any activity that involves bending your knee. Getting the VMO working better will go a long way to correcting the MALTRACKING!

On examination of your knee, it is common to see A MUSCLE IMBALANCE BETWEEN YOUR QUADRICEPS MUSCLES.

If there is a muscle imbalance between the quadriceps muscles: vastus lateralis (VL), which pulls your patella up and outwards, and the vastus medialis oblique (VMO), which is the only quadriceps muscle that pulls your kneecap up and slightly in, then your patella will track laterally in the groove, causing maltracking.

The two main ways the imbalance will occur is with VMO weakness and/or tight lateral structures. VMO weakness can be caused by trauma or from knee pain post-surgery. Tight lateral structures can occur from training errors and poor biomechanics.

Research also shows…

  • Hip muscles are very important in the control of your thigh. Poor buttock muscle control “glutes” allows your knee to roll in and apply a relative lateral displacement of the patella. Most successful rehabilitation programs require assessment and correction of your hip and buttock muscle control too!!!
  • Poor foot posture aka flat feet, and weak hip control muscles, can both allow your knee to abnormally twist and result in a lateral deviation of your kneecap
  • When poor biomechanics are repeated with each step of your walking or running pattern, that poor habit repeatedly flares-up your knee
  • Researchers have confirmed that physiotherapy intervention is a very effective short and long-term solution for knee pain.
  • Your exercises need to suit your level of ability. Exercises can take some time to notice results, so patience is key. Doing too much or too little will stall your progress!

Great news too, you don’t need to give up squats and lunges just yet!


What can be done? I challenge you to take action against your knee pain!

If you have tried “physio” before, and they just placed a heat pack on your knee – then you haven’t tried real physio yet!

If you have tried “physio” before, and this involved attaching a machine to your knee – then guess what? You haven’t tried real physio yet!

If you have tried “physio” before, and you have been told to stop squatting and lunges – then you know what’s coming! You haven’t tried real physio yet!!!

This is an amazing opportunity to see what can and should be done for your knee pain – you owe it to yourself to get a proper assessment and a proper management plan developed. Have you ever heard of a rugby player with their big thighs missing a game due to this type of knee pain… me neither!

I’m so confident we can help you that we’d love to chat with you personally about your knee or knees! Just click HERE and enter your details, and a rough time that you’d like me to contact you and we’ll be more than happy to explain how we can have you knee pain free and enjoying your life again!

Book an appointment here to start improving your knee pain or injury today!

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