Optimising Cycling Performance. North Yorkshire

Patellofemoral Pain

Patellofemoral Pain Syndrome

 Patella femoral anatomy

Patella femoral anatomy


What is Patellofemoral Pain Syndrome?


Your patellofemoral joint is between your kneecap (patella) and your thigh bone (femur). It makes up a part of your knee joint, being contained within the same water tight sack (joint capsule) and can be seen in the picture above. As you can see it is actually quite separate from your main tibiofemoral joint (between your shin and thigh bones). It has a differing task to the rest of your knee joint, thus tends to give different types of symptoms and therefore should be dealt with from a treatment and diagnostic sense as a subtly separate entity.

The term Patellofemoral Pain Syndrome, shortened to PFPS, relates to any pain felt arising from this and related structures. This is an interchangeable term with the also commonly used anterior knee pain (frontal knee pain)

Not everyone likes this term; it sounds like something born out of a committee. In truth it was. It came out of the realization by the academic community that not all pain coming from the knee-cap can be explained by a problem with anatomy (bones, tendons, misalignment).

  • Some pain is present in the absence of altered anatomy
  • Some people with altered anatomy have no pain.
  • Some people with altered anatomy have pain arising from something unrelated to their anatomical variation.

Sounds complicated doesn’t it? In truth, to an experienced specialist, diagnosis is simply a quality assessment and some rational thought away. However explaining the nuances of all the potential reasons for PFPS in this forum may just send you to sleep, or give you a headache to go with your knee pain!

As specialists we recognize a number of different clinical entities that are encompassed within the umbrella term of PFPS. These include:

  • OA knee
  • Patella tendinopathy
  • Lateral facet overload
  • Patella osteochondral defect
  • Symptomatic plica
  • Hoffas fat pad irritation
  • Chondromalacia patellae

However some folk have similar presentations of knee pain in the absence of any of these.

PFPS tends to affect women more than men, is more prevalent in adolescence but then tends to raise again as people get into their 50’s and over.


What are the symptoms of Patellofemoral Pain Syndrome?


PFPS commonly presents with pain arising from the front of the knee. It is usually located around the kneecap itself.

This pain is usually worse when more load is placed up on the knee cap. Ascending stairs seems to particularly aggravate PFPS due to the added pressure of lifting your body on a bent knee. However people will commonly struggle also with:

  • Prolonged sitting
  • Kneeling
  • Getting out of chairs

Some people may find that, if their pain is intense enough, the knee can feel that it will give way. People can report the knee buckles with pain, particularly when going up or down stairs.


What can I do for myself?


If you have had a sudden flare up of pain it is a good idea to treat the knee kindly, let it settle. Following the advice here on the management of an acute injury is a great place to start.

As things start to settle it is important to start to re-load your kneecap. Avoiding the use of your kneecap by walking up and down the stairs sideways, a common work around people use tends only to prolong matters.

It is often useful to start the process of rehabilitating your kneecap slowly. Starting with some simple exercises such as these.  It is okay to feel some pain when doing these, but it should go off as soon as you stop exercising. They should not leave your knee aggravated.

As things start to get easier you could start to try this exercise.

Only lunge as far as you can so your knee pain is not left worse after you have done.

Once you start this journey to recovery how far you continue depends on what you wish to get back to doing. If you have a specific sport or hobby that you wish to return to then gaining the help of a rehabilitation specialist would be advised. This is something we would be able to help you with.

If you struggle with this self help management then we are always happy to help with your diagnostic and rehabilitation needs.


What other treatments are available?


Up to now we have talked about PFPS as a singular problem. In truth there are lots of different issues that can give the symptoms of PFPS. Some of these are listed above.

If the self-help advice given on this page does not work then where treatment goes from here depends upon what specific features a person presents with. This is when the expert attentions of a specialist are invaluable. 

The complexity of the leg and the loads that it has to deal with means that sometimes a more bespoke program of physical therapy is required.

Specific physiotherapy

A physiotherapy session with one of our knee specialists at Cycloform Physiotherapy will include a bespoke assessment, diagnosis and then identification of your treatment needs. This may include

  • Manual therapy (manipulation),
  • Strength and conditioning exercise.
  • Advice. You will be able to draw on our experts many years of treatment experience to help you regain control of your symptoms.

If you need our help with physiotherapy you can book here.


If you have a degenerative element to your problem sometimes a rehabilitation regime augmented with a hyaluronic acid or steroid injection can help then process.


There are a number of surgical techniques available to people with PFPS. Which one if any is suitable for you is a complex decision based on further diagnostic tests (MRI, X-ray) and a considered view on the risks and rewards.

At Cycloform Physiotherapy our knee specialists have many years of experience of working along side specialist knee surgeons here in York. Our excellent working relationships based on years of mutual respect and many hours working closely in clinics together mean we are well placed to be able to give you help with making a decision.

Week in week out we help people through this decision making process, while possessing the expert skills to undertake the conservative treatment that is require. This means that you can stay informed of your options throughout treatment and make decisions when and how they suit you. If you wish for a bespoke assessment of your options please book in with a knee specialist here.