xray image of the knee joint

Patellofemoral Pain

By Alison McIntosh

Patellofemoral pain (and patellofemoral dysfunction) are a common causes of pain felt at the front of the knee. This pain originates from the joint between the patella (the kneecap) and the femur (thigh bone).

The patella usually glides/ tracks through the patella groove on the femur during flexion and extension of the knee. Compression is a natural component of this movement however an increase in the compressive force at this joint can result in patellofemoral pain. This can be caused by an alteration in the position of the patella (interfering with its smooth tracking during knee movements). An altered position of the patella is commonly a result of quadriceps (front thigh muscle) imbalance.

The most common imbalance occurs when the pull of the outer quadriceps muscle (Vastus Lateralis) is too strong compared with the pull of the the inner quadriceps VMO (Vastus Medialis Obliquus) which is often too weak. If the lateral structures of the knee (Iliotibial band and Retinaculum) are very tight this adds to the problem, which is known as ‘patella maltracking’.

Common signs and symptoms of patellofemoral pain:

  • Pain underneath the kneecap
  • Knee pain with rising to standing from a seated position
  • Knee pain associated with prolonged knee flexion (eg sitting in the movies/ on an plane)
  • Knee pain with climbing and particularly descending stairs
  • Knee pain with running , hopping, squats, lunges

Common causes of patellofemoral pain:

  • Over pronation of the feet ‘dropped arches’ as a result of
    • poor foot wear (inappropriate arch support)
    • a genetic pre-disposition (possibly a family history of hypermobility ) or
    • as a result of poor gluteal strength (important in maintaining a neutral lower limb alignment)
  • Over loading of the joint as a result of
    • biomechanics (one stronger more dominant limb)
    • occupational causes
    • sporting limb dominance
  • Recent changes to an exercise regime i.e.
    • recent commencement of running
    • alteration of fitness regime to include squats, lunges, hill or stair training
    • recent increase in intensity of a training program


A diagnosis of patellofemoral pain or patellofemoral dysfunction is usually made without the need for medical imaging. A physiotherapy assessment will frequently involve:

  • Specific orthopaedic testing of the patello femoral joint
  • Biomechanical analysis
  • Gait analysis
  • Functional testing of the knee, ankle hip and pelvis
  • Knee ligament testing to aid in identifying any additional knee ligament or cartilage involvement
  • Hip and lumbar spine testing to aid in identifying any referred pain
  • Functional assessment to determine strength/balance/alignment


The first aim of treatment is usually to reduce pain in the short term. At Free2Move we frequently use a patient specific combination of the following modalities

  • Acupuncture
  • Soft tissue massage
  • Joint mobilisations
  • Taping
  • Neuro muscular re-education through the Feldenkrais Method
  • Foot wear advice and arch support taping
  • Exercise/training modification

Secondly, treatment of patellofemoral pain would aim to restore efficient bio-mechanics, improve function and if required focus on sport specific rehabilitation. This may be achieved using:

  • Feldenkrais Method
  • Clinical Pilates
  • Patient specific home exercise program ultimately aiming to reduce the likelihood of any re-occurrence of the problem

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