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Patellofemoral pain syndrome
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Patellofemoral pain syndrome at HCA UK
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When patellofemoral pain affects your quality of life, we offer fast access to the latest tests and imaging for fast, accurate diagnosis and tailored treatment from our expert knee specialists.
We have a higher proportion of 'Outstanding' ratings from the Care Quality Commission (CQC) than any other private healthcare group in the UK. No wonder 97% of our patients are likely to recommend HCA UK to their family and friends*.
*Based on our 2024 patient satisfaction survey report
Patellofemoral pain syndrome (PFPS), also known as ‘runner’s knee’, is a common condition that causes pain at the front of the knee joint and around the kneecap (patella).
PFPS is caused by a structural defect in the knee or a biomechanical factor that puts too much stress on your kneecap during high-impact activities.
At HCA UK, we offer a range of specialist, effective treatments to reduce the pain and discomfort of patellofemoral pain syndrome, with orthopaedic consultants who specialise in knee injuries and conditions.
PFPS is caused by a structural defect in the knee or a biomechanical factor that puts too much stress on your kneecap during high-impact activities.
At HCA UK, we offer a range of specialist, effective treatments to reduce the pain and discomfort of patellofemoral pain syndrome, with orthopaedic consultants who specialise in knee injuries and conditions.
Although, in rare cases, patellofemoral pain syndrome can be caused by a specific impact injury, or a change in training routine or intensity, it’s usually due to a combination of inherent genetic, environmental and lifestyle factors, which makes it hard to pinpoint an exact cause. For some people, a sudden change in training schedule or running on a new surface without changing footwear can aggravate patellofemoral pain.
Some of the causes include:
- The kneecap being too high in the knee joint
- Starting a new activity or sport
- Suddenly increasing the intensity or frequency of an existing activity
- Reduced activity levels (leading to muscle weakness)
- Poor training techniques
- Muscle tightness or weakness in the hip and knee
- Wearing unsupportive footwear such as flat shoes or high heels
- Previous injuries
- Being overweight
- Spending too long kneeling at work
The main symptom of patellofemoral pain syndrome is pain in one or both knees. Individuals with PFPS typically describe an aching sensation at the front of the knee that gets worse after prolonged periods standing, running or engaging in impact sports. In the most severe cases, everyday activities like using the stairs and kneeling can be very painful.
Some of the most common symptoms include:
- Pain in the front of the knee, around and behind the kneecap
- Pain that gets worse after exercise
- Pain that gets worse after prolonged sitting
- Pain when going downstairs or squatting
- Crunching, clicking or a grating sensation that you can feel and/or hear in your knee. It may get worse when you bend or straighten your knee
It’s always a good idea to check out any intense or persistent knee pain and get an expert opinion. Without the right treatment, people experiencing patellofemoral pain syndrome can develop strains, injuries and even biomechanical irregularities as the body starts to overcompensate for the knee pain through a series of adaptive (but often problematic) movements and movement patterns.
If left untreated, runner's knee can lead to permanent damage and leave you prone to developing knee arthritis.
If left untreated, runner's knee can lead to permanent damage and leave you prone to developing knee arthritis.
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TESTS AND SCANS AT HCA UK
Fast access to diagnostics: How is patellofemoral pain syndrome diagnosed?
Our consultants have years of experience in diagnosing and treating all kinds of knee pain. If you're experiencing knee pain, your consultant will begin by asking you questions about your medical history, and any activities (such as high-impact sports) you like doing. They'll ask you about your symptoms and physically examine your knee. You might be asked to perform certain movements if you're able to.
Once your consultant has completed the physical examination, they'll normally request same-day imaging at one of our state-of-the-art diagnostic centres to confirm the diagnosis.
Some tests they might recommend include:
- X-rays
- CT scans
- MRI scans
- Ultrasound
ORTHOPAEDIC CARE AT HCA UK
Treatment options for patellofemoral pain syndrome
The best treatment options for you will depend on the cause of your patellofemoral pain syndrome and the severity of your symptoms.
Treatment may well start with lifestyle modifications such as changes to your diet and exercise regime, new sports footwear or specialist orthotics and physiotherapy to strengthen the muscles supporting the knee.
For milder cases, this may be sufficient to manage your symptoms. For more serious symptoms your consultant may recommend a surgical intervention such as knee arthroscopy or knee realignment surgery.
Knee arthroscopy: Your surgeon will insert a device with a small camera (arthroscope), into the knee through a small incision. This allows them to thoroughly examine the inside of the knee joint to see what's causing you pain. If required, surgical tools can then be inserted through other small incisions to repair the problem.
Knee realignment surgery: This will only be recommended in extreme cases. The procedure treats patellofemoral pain syndrome by relieving pressure within the knee joint. The shinbone (tibia) is cut and shaped to ensure the kneecap can move as it should within the trochlear groove at the end of the thigh bone (femur). This stops the kneecap from irritating the surrounding soft tissue.
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FAQs
As you bend and extend your knee, the kneecap slides up and down in a groove on your thigh bone (femur). PFPS can be caused by damage to the soft tissue that supports and cushions the kneecap.
In some cases, patellofemoral pain syndrome can lead to damage to the articular cartilage on the underside of the kneecap. This often results in further pain.
In some cases, patellofemoral pain syndrome can lead to damage to the articular cartilage on the underside of the kneecap. This often results in further pain.
Exercise is usually beneficial, so it can be frustrating if your knee pain is a result of increased activity. Most people who experience patellofemoral pain do so because the body is unable to cope with the increased load. This is usually the case if you try to do too much too soon.
As patellofemoral pain can be caused by damage to the soft tissue surrounding the kneecap or elsewhere in the joint, you'll aggravate the injury every time you bend or extend your leg. This is because bending the knee causes the kneecap to rub against the damaged soft tissue and is exacerbated by increases in activity level and intensity, as well as changes to your exercise routine, environment or footwear. It’s always important to introduce new exercises slowly over an extended period of time.
As patellofemoral pain can be caused by damage to the soft tissue surrounding the kneecap or elsewhere in the joint, you'll aggravate the injury every time you bend or extend your leg. This is because bending the knee causes the kneecap to rub against the damaged soft tissue and is exacerbated by increases in activity level and intensity, as well as changes to your exercise routine, environment or footwear. It’s always important to introduce new exercises slowly over an extended period of time.
Patellofemoral pain syndrome is a very common condition affecting around a quarter of adults and a third of adolescents at some point in their lives.
Women are twice as likely as men to develop PFPS. This is because of a variety of biomechanical and anatomical differences. Individuals who undergo ACL surgery can also experience weak quadriceps, which can also contribute to PFPS.
Women are twice as likely as men to develop PFPS. This is because of a variety of biomechanical and anatomical differences. Individuals who undergo ACL surgery can also experience weak quadriceps, which can also contribute to PFPS.
Most people who are diagnosed with patellofemoral pain syndrome see dramatic improvements in their knee pain after starting a programme of patellofemoral pain syndrome exercises and making certain lifestyle changes. The right physiotherapy programme will target the muscles surrounding the knee joint, encouraging it to track correctly. Usually this is enough to make your symptoms go away on their own.
Most people will find that their patellofemoral pain syndrome is resolved after a few weeks or months. If your PFPS isn't responding to conservative management treatments, surgery may be required.
Most people will find that their patellofemoral pain syndrome is resolved after a few weeks or months. If your PFPS isn't responding to conservative management treatments, surgery may be required.
If patellofemoral pain syndrome is causing you discomfort, there are a few home remedies that can provide relief. These include:
- The RICE method: A simple self-care technique involving rest, ice, compression and elevation. By applying ice to the affected area and taking plenty of rest, you'll usually see some improvements in your knee pain.
- Over-the-counter painkillers such as paracetamol, ibuprofen or naproxen.
- PFPS knee brace providing additional support and compression to minimise pain, allow any damaged tissue to heal properly and protect your knee from further damage.
- Reduced activity levels including avoiding certain movements that put excessive pressure on the knee joint, such as lunging and deep squatting.
Yes, if you’re suffering from patellofemoral pain it can be really helpful to protect the knee from further damage with either a brace or taping of the patella. Doing so can be very effective for reducing pain during activity, and helps to complement any exercise programme you are following. Your consultant or physiotherapist will let you know which approach is right for you at the moment.
Your consultant or physiotherapist will give you further advice on the specific exercise regime that’s right for you. Rather than stopping all forms of activity, which can heighten symptoms by weakening the muscles surrounding your knee joint, it's usually best to modify your exercise programme.
To start with, your consultant will usually recommend pacing your activity and breaking your daily exercise routine into smaller units of activity to reduce the strain on your knee. You might also need to adjust your exercise regime slightly if you regularly experience pain. For example, if running aggravates your symptoms, try reducing your number of times you run in the week, running shorter distances, or choosing flatter routes.
If you still feel discomfort during or after high-impact exercises like running, your consultant might recommend alternative forms of exercise such as swimming and cycling. This is because they're non-impact activities that'll help you build strength in the muscles surrounding the knee without worsening your injury.
To start with, your consultant will usually recommend pacing your activity and breaking your daily exercise routine into smaller units of activity to reduce the strain on your knee. You might also need to adjust your exercise regime slightly if you regularly experience pain. For example, if running aggravates your symptoms, try reducing your number of times you run in the week, running shorter distances, or choosing flatter routes.
If you still feel discomfort during or after high-impact exercises like running, your consultant might recommend alternative forms of exercise such as swimming and cycling. This is because they're non-impact activities that'll help you build strength in the muscles surrounding the knee without worsening your injury.
Very important. Losing weight can reduce the pressure on your knees and provide relief from the symptoms of your patellofemoral pain syndrome, so your consultant may well also recommend a programme of weight management. Clinical trials have shown that for every pound of weight lost, four pounds of pressure is taken off the knees.
Orthotics made from viscoelastic material are very helpful for people with runner's knee. Orthotics work by reducing the impact that running has on the knee joint. As well as absorbing the shocks from impact sports, orthotics help stabilise your foot and ankle. This means that you can support healthy alignment of the knee, reducing damage to the surrounding tissue.
Yes, a personalised, well-structured physiotherapy programme is the go-to treatment for patellofemoral pain syndrome.
At HCA UK, our specialist physiotherapists will look at the root cause of your knee pain and recommend specific exercises to improve your range of movement, strength and endurance. You may be prescribed exercises to strengthen the muscles surrounding your knees and hips or improve the flexibility of your hamstring, calf and quad. It might be a combination of both. This may include a phased return to sport and regular outpatient appointments.
At HCA UK, our specialist physiotherapists will look at the root cause of your knee pain and recommend specific exercises to improve your range of movement, strength and endurance. You may be prescribed exercises to strengthen the muscles surrounding your knees and hips or improve the flexibility of your hamstring, calf and quad. It might be a combination of both. This may include a phased return to sport and regular outpatient appointments.
Unfortunately, there isn't a quick fix for patellofemoral pain syndrome as you'll need to build up strength and flexibility in the surrounding muscles to alleviate your symptoms. It usually takes around six weeks to recover with non-surgical PFPS knee treatment. To maintain strength and flexibility in your knee joint, you'll usually have to continue your physiotherapy exercises to ensure your PFPS doesn't come back.
In the unlikely event you need surgery for your patellofemoral pain syndrome, the recovery can be much longer. In some cases, it'll take several months and it's important to continue your physio post-surgery to get the best results.
If you fail to maintain the strength and flexibility in your knee, the muscles can become tight or weak. This can then cause the PFPS to come back. For this reason, surgery is only recommended as a last resort and it should be combined with non-invasive treatments for optimum results.
In the unlikely event you need surgery for your patellofemoral pain syndrome, the recovery can be much longer. In some cases, it'll take several months and it's important to continue your physio post-surgery to get the best results.
If you fail to maintain the strength and flexibility in your knee, the muscles can become tight or weak. This can then cause the PFPS to come back. For this reason, surgery is only recommended as a last resort and it should be combined with non-invasive treatments for optimum results.
The cost of your treatment will depend on the package of care your consultant recommends. For your peace of mind, we offer transparent pricing and will outline exactly what’s included in your treatment package and the overall amount you can expect to pay. It’s important to be aware that the final cost of your treatment will depend on the specific diagnostic and treatment plan that your consultant agrees is right for you.
Patient stories
Decades of pain, resolved in weeks
Now 46, Mike had been struggling with knee problems since he tore his right ACL during a football match at the age of 19.
Sarah-Jane’s return from knee injury
It was when she slipped on the dancefloor at an office party that 38-year-old Sarah-Jane finally realised something wasn’t right with her knee. A keen skateboarder and tennis player, Sarah-Jane had always led an active lifestyle, but never thought much about injuries.
Decades of knee pain: Judith's story
Retired physiotherapist and keen artist, Judith has had knee pain since she was in her forties. At the age of 81, after years of suffering, she made the decision to explore her options to cure her knee pain.
“With hindsight, I should have dealt with my knee problems a long time ago. I’d say to anyone else in my position that if you’re not sure about anything, you should seek the help of a specialist.”
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*Based on our patient satisfaction survey at HCA UK hospitals.
**Based on national private orthopaedic volumes, The Private Healthcare Information Network.
***Based on availability across all HCA UK facilities.
This content is intended for general information only and does not replace the need for personal advice from a qualified health professional.