One of the most common knee complaints is a condition called patellofemoral pain syndrome (PFPS). It frequently presents as a dull, throbbing pain around the knee cap (patella). Some patients complain of a clicking sensation when sitting for a period of time and then standing. It can also cause buckling in the knee, where the knee “gives out” when walking or standing. There are many causes of PFPS, most of which can be attributed to one common denominator, weakness in the quadricep muscle. Mostly, it is a supply and demand issue: does the quadriceps (quad) have the muscle supply to meet the demand of the activity? I always tell patients that this can happen to anyone, even Gronk! Now, Gronk on his weakest day will be stronger than most of us on our strongest day! However, if he increases the demand of his quad, (regardless of how strong he is), and it does not have the supply for that demand, he can have PFPS. I have found that it mostly frequently occurs in the spring and fall, when we become more active from a dormant winter or decide to play a fall sport after a summer of relaxation! It can also occur after an injury to one leg where we may or may not be aware that we are favoring that leg and it becomes weaker. There is no age or gender discrimination with PFPS and it can affect one or both knees. The quadriceps complex consists of the quad muscle, quad tendon, patella, patellar tendon. It’s like saying Route 2, South County Trail, Bald Hill Road, Reservoir Avenue. All the same road, just named for each region. The patella is embedded in the quad complex, therefore the quad muscle dictates where the patella goes. If the quad isn’t strong enough to keep the patella seated in the groove it rides in the thigh bone (femur), the patella shifts and slides around in it. Picture a rope riding in a pulley: the rope never leaves the pulley, but it rides along the sides of it, then snaps back down into the groove. The “snap” or clicking sensation is a frequent symptom and complaint of PFPS. Now imagine the rope fraying because it’s sliding all around: that’s like the inflammation that causes the dull, throbbing, aching pain around the patella. The treatment for PFPS is physical therapy (PT). There is no surgical intervention for PFPS. The goal of PT is a graduated strengthening regimen. It is important to have realistic expectations with this. If the issue has been ongoing for several months, it is going to take several weeks to begin to feel improvement. Many patients get discouraged at the length of time this can take. Continuing a daily home exercise program is integral for the first few months. Stick with it and you’ll notice the pain and buckling subside!