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Pain toward the front of the knee and around the patella (knee cap) could be due to a condition called patellofemoral pain syndrome (PFPS). It typically occurs in physically active people aged < 40 years, women 2X more likely than men, but can affect individuals of all activity levels and ages. Sometimes referred to as “runner’s knee”, it is common in people who participate in sports involving jumping and running. It is one of the most common knee diagnoses seen in a sports medicine clinic.

The patella which is commonly known as the knee-cap is located in the front of your knee. It sits inside of the trochlear groove on the front of the femur (thighbone). The patella is located underneath the tendon of the quadriceps muscle which is the large muscle on the front of the thigh.

With every step, squat, stair a person makes, the patella is designed to glide smoothly in the groove on the femur.


Overuse vigorous activities that put repeated stress on the knee especially high impact such as running and climbing stairs

Sudden change in physical activity (increased frequency/duration/intensity of workout).

Patellar Malalignment causes abnormal gliding of the patella in the trochlear groove. This can cause pressure to the back of the patella and irritation of surrounding soft tissue

Muscle imbalance/weakness: i.e., weak gluteus/quadriceps musculature/tight hamstrings calf muscles and IT band can cause patellar malalignment and inward movement of the knee during functional activities

Flat feet


Dull aching pain toward the front of one or both knees
Pain with exercise that repeatedly bends the knee
Pain after sitting for a prolonged period of time with knees bent
Popping or crackling sounds in the knee when climbing stairs or standing after prolonged sitting


A diagnosis of PFPS is that of exclusion. Your doctor will conduct a thorough physical examination of the structures of your knee. An x-ray can help rule out other structural abnormalities such as malalignment, arthritis and fractures.


Once you receive your diagnosis, it is important to rest the affected extremity and avoid pain provoking activities. Icing and elevating the affected limb are additional measures to decrease inflammation.

The good news is that patellofemoral pain syndrome is a condition that usually resolves with conservative measures and very rarely requires surgery. Some treatment may include:

Medications Your doctor may recommend Ibuprofen/Naproxen or Tylenol

Cortisone Injection Your doctor may recommend injection if OTC meds are not a feasible option

Physical therapy Your therapist will evaluate your posture, range of motion, strength, gait and if needed, running analysis and can prescribe specific exercises to strengthen the muscles that support your knee and control limb alignment. Additionally, he/she can help correct faulty movement patterns. It is important to keep exercising your legs in this healing phase in non-painful ranges of motion. Your therapist may also recommend bracing for support of the patella or an orthotic to support the arch of the foot during the healing phase.


Warm up before vigorous activity (i.e., dynamic stretching of quad/hamstrings)
Appropriate footwear for your sport is recommended
Maintain a healthy body weight
Gradual increase in exercise intensity/duration/frequency
Cross training if high impact activities exacerbate your knee pain, try incorporating low impact activities such as biking swimming elliptical trainer


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