Patellofemoral Pain Syndrome (PFPS): Understanding Pain at the Front of your Knee

What Is Patellofemoral Pain Syndrome?

Patellofemoral Pain Syndrome (PFPS) is a condition characterised by pain at the front of the knee, around or behind the kneecap (patella) (1). It is often referred to as “runner’s knee” because it commonly affects active people. PFPS typically feels like a dull ache in the front of the knee that gets worse with activities such as climbing stairs, squatting, or sitting with knees bent for a long time (sometimes called the “movie theatre sign”) (1). This syndrome is very common. In fact, it’s one of the most frequent causes of anterior knee pain seen by clinicians (1). It can affect one or both knees and usually comes on gradually rather than from a single injury, or after acutely ramping up physical activity levels. While PFPS can affect anyone, it’s especially common in teenagers and young adults who are physically active, and it tends to be reported more often in women (1).

What Causes PFPS?

PFPS is typically an overuse injury with multiple contributing factors rather than one single cause (2). In simple terms, it happens when the stress on the kneecap joint exceeds what the tissues can handle. Common factors that can contribute to PFPS include:

• Overuse or Repetitive Strain: Frequently running, jumping, or kneeling can overload the knee joint. Many people with PFPS report their pain began during a period of increased training or activity (1, 2). Sudden changes (like starting a new sport or dramatically increasing workout intensity) can trigger it (1).
• Muscle Weakness or Imbalance: Weakness in the muscles around the knee and hip, especially the quadriceps (front thigh), means the kneecap isn’t optimally supported. Tight muscles can also alter kneecap movement and put extra pressure on the joint (2).
• Knee Alignment and Patellar Tracking: Subtle differences in anatomy or alignment (such as a kneecap that sits slightly off-centre or flat feet that alter leg mechanics) may contribute to PFPS in some people (2). If the patella doesn’t slide smoothly in the femoral groove, it can cause irritation (2).

It’s important to note that PFPS is usually multi-factorial. Often a combination of the above issues come together to cause the knee pain. Interestingly, research shows that many presumed risk factors (like age, weight, or generic alignment measures) don’t consistently predict who will get PFPS (2). However, having weaker quadriceps muscles has been linked to a higher risk of developing patellofemoral pain (2). The good news is that most of these factors, especially muscle strength and training habits, are modifiable. This is where physiotherapy can make a big difference.

Can Physiotherapy Help with PFPS?

Absolutely! Physiotherapy is the first-line treatment for PFPS and has a strong track record of success. In fact, the vast majority of people with patellofemoral pain improve without surgery, given proper rehab. Studies have shown that about two-thirds of patients see significant improvement with a tailored physiotherapy program (1). Typical physiotherapy for PFPS addresses both symptom relief and the underlying causes of your knee pain. This combined approach helps not only to ease the pain but also to prevent the problem from coming back.

One of the main focuses in physio is exercise therapy, strengthening and balancing the muscles around your knee and hip. Research consistently shows that a structured exercise program can significantly reduce pain and improve function in PFPS (1, 3). Building up the quads, glutes, and other supporting muscles helps take the strain off your kneecap. Exercise is so important that recent guidelines recommend knee-targeted (and often hip-targeted) exercises with education as the primary treatment for patellofemoral pain (3). In addition to exercises, physiotherapists will usually incorporate other useful treatments based on your needs. For example, hands-on manual therapy, taping techniques, or foot orthotics, to support and enhance the exercise program (3). Combining exercise with these additional therapies has been shown to yield better short-term results for pain and function than exercise alone in many cases (3).

How Can Fit2Function Help You?

At Fit2Function, we take a comprehensive approach to PFPS, using a range of evidence-based treatments to help you recover. We understand that patellofemoral pain can be frustrating, but with the right care, you can get back to pain-free function. Our services for PFPS include:

• K-Laser Therapy: This is a form of high-intensity therapeutic laser that we use to induce healing in the knee This stimulates blood flow and tissue healing in the painful area. Research has shown that adding laser therapy to exercise can significantly improve pain relief and knee function in PFPS (4). It’s a painless, quick treatment that can kick-start your recovery, especially in the early phase when your knee is very sore.
• Electrical Muscle Stimulation (EMS): PFPS often leads to inhibition (shutdown) of the quadriceps muscle, particularly the VMO (vastus medialis) on the inner side of the thigh. We use EMS to gently activate and strengthen these muscles. By placing pads on your thigh, EMS sends mild electrical pulses that make your muscles contract. This can help improve quadriceps strength and knee stability when exercises alone are difficult. Some studies have found that combining EMS with exercise can further reduce pain and improve muscle function in people with patellofemoral pain (5). EMS essentially “wakes up” the muscle, so you can rebuild strength more effectively.
• Manual Therapy: Our physiotherapists are skilled in hands-on techniques to help your knee move and feel better. Manual therapy can include patellar mobilisations (gentle glides of the kneecap), soft tissue massage to tight muscles or IT band, and knee or hip joint mobilisation if needed. These techniques can improve your knee’s range of motion and relieve discomfort. There is evidence that incorporating manual therapy for the leg can improve short-term function in PFPS when combined with exercise (1, 3). In practice, manual therapy often helps “loosen up” any stiff or tender spots, making your exercises easier to do and more effective.
• Patellar Taping: We often use taping techniques to support the kneecap. In PFPS, taping the patella can provide immediate pain relief by improving kneecap alignment and reducing stress on the irritated tissues. It’s a simple measure but can make a big difference. Taping is one of the recommended supportive interventions for PFPS (3). Our therapists will apply tape in a specific pattern to slightly adjust how your kneecap tracks, based on what we find in your assessment. We can also teach you how to tape your knee for those times you want extra support (like before a run).
• Tailored Exercise Program: Exercise is the cornerstone of PFPS management, and at Fit2Function you will receive a personalised exercise prescription. This typically includes strengthening exercises for your quads, glutes, and core, as well as stretching for any tight structures. We’ll also incorporate functional exercises, think single-leg squats or step-downs, to practice good knee control. By doing your tailored exercises consistently, you’ll build the resilience of your knee so it can handle your daily activities and sports without pain (1, 3). Importantly, we progress the exercises in stages to match your improvement, ensuring you continue to gain strength and confidence in your knee.

By combining these treatments, Fit2Function addresses both the symptoms and the causes of PFPS. Our goal is not only to get you out of pain, but also to fix the underlying issues to keep you pain-free. We will work closely with you through each stage of rehab, guiding your return to the activities you enjoy. Patellofemoral pain may be common, but with the right approach, you can overcome it. If you’re struggling with anterior knee pain, our team at Fit2Function is here to help you get back to full function, fit and pain-free.

References

1. Neal BS, Lack SD, Bartholomew C, Morrissey D. Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning. British Journal of Sports Medicine. 2024 Oct 14;58(24):1486–95. doi:10.1136/bjsports-2024-108110
2. Neal B, Lack S, Lankhorst N, Raye A, Morrissey D, Middelkoop MV. 7 risk factors for Patellofemoral Pain: A systematic review & meta-analysis. Abstracts. 2018 Apr; doi:10.1136/bjsports-2018-099334.7
3. Neal BS, Bartholomew C, Barton CJ, Morrissey D, Lack SD. Six treatments have positive effects at 3 months for people with Patellofemoral Pain: A systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2022 Nov;52(11):750–68. doi:10.2519/jospt.2022.11359
4. Ozlu O, Atilgan E. The effect of high-intensity laser therapy on pain and lower extremity function in patellofemoral pain syndrome: A single-blind randomized controlled trial. Lasers in Medical Science. 2024 Apr 17;39(1). doi:10.1007/s10103-024-04017-y
5. Abdelhamed AI, Mortada H, Hendawy A, Elfeky A, Kamel RM, Elshennawy S. The effectiveness of neuromuscular electrical stimulation on pain, function, and quadriceps muscle strength in adults with patellofemoral pain: A systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2025 Aug 9;26(1). doi:10.1186/s12891-025-09029-5