Patellofemoral Pain Syndrome

What Is Patellofemoral Pain Syndrome (PFPS)?

Patellofemoral pain syndrome (PFPS) is pain in the front part of the knee, around the knee cap.
A diagnosis of PFPS is generally provided when other causes of your knee pain (such as a ligament or muscle injury) have been ruled out.


What Causes Patellofemoral Pain Syndrome (PFPS)? What Are Common Symptoms Of PFPS?

PFPS is a result of an imbalance in the muscles of the leg that causes an abnormal pull at the knee cap, making it track differently than normal and causing irritation to the structures surrounding it. Someone presenting with PFPS will often have some combination of weakness in the muscles of the hip and/or foot, along with tightness through the hip and thigh. Sometimes however, it is less about weakness and more about how well we activate or fire (or don’t activate or fire) the muscles during an activity that can cause our knee pain.


Common symptoms of PFPS include:

  • Pain around the kneecap
  • Pain following prolonged sitting (theatre sign)
  • Pain with squatting activities and stairs
  • Clicking/cracking around the kneecap
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How Can Physiotherapy Help My Patellofemoral Pain Syndrome (PFPS)?

A Physiotherapy can help treat your PFPS by first identifying the specific muscles that are contributing to YOUR symptoms and tailoring your treatment accordingly. Your Strive Physiotherapist  can employ a variety of hands on skills such as massage, passive stretches, and even mobilizations to the knee cap in order to decrease the tightness in relevant muscles and improve your pain. You will be given a tailored exercise program aimed at strengthening the appropriate muscles and ensuring the correct muscles are firing throughout movements (such as when squatting, climbing stairs or getting in and out of chair). You may also receive treatments such as taping to control the tracking at the kneecap and/or Acupuncture and Dry Needling to address muscle tightness and pain.


How Can A Pedorthist Help My Patellofemoral Pain Syndrome (PFPS)?

Pedorthist can assess how your lower leg and foot move and adapt to different surfaces, shoes and activities. Your Strive Pedorthist can perform a gait and running analysis and give you advice on the type of footware that will best suit your foot and the activities you like to do. In some cases, custom orthotics may be recommended to provide your foot and lower leg with improved support

How Can Massage Therapy Help My Patellofemoral Pain Syndrome (PFPS)?

Massage therapy can also be used to treat the tightness in the muscles of the hip, lower back and thigh that are contributing to your symptoms. Your Strive Massage Therapist is skilled at muscle and fascial release techniques that are beneficial in reducing tone in the muscles contributing to your knee pain. They can also address any painful and tight muscles that develop from compensating (moving differently) for your painful knee.


How Can Sports Medicine/Physiatry Help My Patellofemoral Pain Syndrome (PFPS)?

In some cases, your physiotherapist or massage therapist may recommend that you see a sports medicine physician for your knee pain. Your Strive Physiatrist and Sports Medicine Physician is an important member of your rehabilitation team as they can order images for your knee (eg. xray, MRI, ultrasound) to determine if there is something else underlying your knee pain such as degeneration on the back of the knee cap (chondromalacia patella), osteoarthritis, or injury to your meniscus. They can also perform various specialized injections such as cortisone and provide medications both oral and topical.

How Long Does It Take For Me To Recover From My Patellofemoral Pain Syndrome (PFPS)?

Timelines for recovery from PFPS can vary, and often depend on how long you had symptoms before seeking treatment and how irritable (easily bothered) your pain is. Generally, someone with newer symptoms can recover in 4-6 weeks following the timelines of muscle strengthening. Someone who has been dealing with their knee pain for a while may take closer to 3 months before feeling like they are consistently on top of their pain. So the sooner you start, the better!


What Are The Best Exercises To Help With My Patellofemoral Pain Syndrome (PFPS)?

To get started with some exercises to help you recover from your patellofemoral pain syndrome, check out the Patellofemoral Pain Syndrome Home Exercise Program. Please keep in mind that these exercises were designed as a place to start to address your symptoms. These exercises should not be performed or continued if they cause or increase your pain in any way. Using these exercises for self-management of your symptoms does not replace the value of being assessed by a Health Professional. If you find you need help, let a Strive Health Professional help you, book your time today!


What Can I Do To Treat My Patellofemoral Pain Syndrome (PFPS) At Home?

Avoid doing the things that aggravate your symptoms. Eg. if your pain is always worse after walking downstairs, try taking them one step at a time for now (leading with your sore leg each time) to avoid flaring up your symptoms while working hard on your recovery.


Muscle release to the IT band and thigh muscles

  • This can include rolling the muscles out with a foam roller or massage stick.

Take frequent breaks from sitting during the day and try to ensure that you are not bending your knees past 90° degrees when sitting.

Written in 2020 by Kiah Brubacher-Cressman, Registered Physiotherapist

Grace Underwood

HBComp (Honours), MSc in Computing, MScPT

Registered Physiotherapist

Grace completed her Master of Science in Physical Therapy at the University of Toronto. Before physiotherapy school she obtained a Bachelor of Computing with a specialization in biomedical applications and a Master of Science in Computing from Queen’s University. During her Physiotherapy education, Grace enjoyed clinical internships in amputee rehabilitation, paediatric neurosurgical rehabilitation, lung transplant rehabilitation, and several out-patient clinics working with patients following joint replacement and fracture, patients with Long COVID, and WSIB patients.

Learn more about Grace Underwood

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