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Patellofemoral Pain Syndrome
Patellofemoral Pain Syndrome

Patellofemoral pain syndrome is a broad term for pain around the front of the knee.  The patellofemoral joint in the knee is where the patella (knee cap) and the thigh bone meet. The pain is most often felt in the front of the knee, above, or on the inner part of the knee cap. Likewise, patellofemoral pain syndrome is known as jumper’s knee or runner’s knee.

Knee anatomy

The knee joint is made up of of three major bones: the femur, the tibia, and the patella. The soft tissue of the knee includes the fat pad, connective tissue, ligaments, tendons, and muscles.

The patellar ligament (patellar tendon), connects the patella to the tibia. The patella and the femur connect via ligaments on the back surface of the patella. 

Pain in the knee comes from the nerves detecting this signal in the soft tissue.  This generalized pain can occur from chondromalacia in the patella itself, which is the breakdown of cartilage tissue. 


This breakdown can change how the knee cap glides, causing swelling in the soft tissue. When the knee cap does not track correctly, it will shift outward in one direction during knee flexion.


Some people have a condition called patella alta.  This is a change in the alignment of the legs between the hips and the ankles.  This change causes the knee cap to rise too high on the femur, therefore leading to discomfort.

More commonly the cause for patella pain syndrome is an imbalance caused by weakness. For example, one of the quadriceps muscles may not be strong enough to pull the knee cap correctly during knee flexion. Similarly, the quadriceps muscle group in the front of the thigh could be overused while the posterior chain ( hamstrings, gluteal muscles, the low back) is underused.

Runners KNee

The symptoms often first appear with squatting, running, or climbing stairs. Any activity requiring the knee to flex under pressure can lead to discomfort.  One will often notice pain or stiffness after sitting for an extended period of time. Upon standing the discomfort becomes apparent.




The treatment for patellofemoral pain syndrome can vary from person to person. At least initially, conservative treatment is the mainstay when weakness or imbalance are the cause.  Resting from the aggravating activities, adding ice, and using NSAID’s for the inflammation are all considered as a first line of defense.


More recently, treatment has evolved to home and formal therapy.  The goal is to prevent stiffness by including stretches as well as soft tissue modalities to decrease any muscular tightness. It is important to note that strengthening the core muscles will lead to improved body mechanics for prevention. There are surgical options when the cause is related to osteoarthritis or chondromalacia, and these may be considered should conservative efforts fail.

Cameron Hunt Reyes, PA-C

Physician Assistant to Suzanne Elton, MD, Kansas City Bone and Joint Clinic