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What is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome is a broad term for pathologies of the patella femoral joint. These soft tissues include the tendons and the fat pad below the patella and the synovial tissue which lines the knee joint.

Chondromalacia patella can be present in some cases of patellofemoral discomfort and is the softening or breakdown of the articular cartilage under the kneecap. The Chondromalacia patella does not cause pain because there are no nerves in the articular cartilage. However, it can cause inflammation of the synovium or pain in the underlying bones.

What Causes Patellofemoral Pain Syndrome?


Many cases of PFPS are due to intense physical activities that place repeated stress on the knees, such as jogging, jumping, squatting, or compressing the patella inefficiently. You can also get it from a sudden increase in your level of physical activity (A change in frequency, such as increasing your exercise days each week). You can also change the intensity or duration of your workout, such as running farther distances or drastically increasing the number of ground contacts with plyometrics.

Patellofemoral pain can also be caused by:

  • Incorrect sports training techniques and equipment
  • Modifications to footwear or the playing surface
  • excessive movement of the patella
  • excessive compression of the patella in the femoral groove

Prevention is Key

A faulty kneecap tracking within the trochlear groove can also cause patellofemoral pain syndrome. The patella is pulled to one side of the groove when the knee is bent. This condition can cause pressure to build up between the patellar and the trochlea. It may also irritate soft tissues.

Poor tracking of the kneecap can be caused by the following:

  • Problems with alignment between the knees and the ankles.
  • Muscular weakness or imbalances, particularly in the quadriceps muscles located at the front of your thigh. The quadriceps muscles and quad tendon help keep the kneecap in the trochlear groove. Bad tracking can result in the kneecap not being within the groove due to weak or imbalanced quadriceps. Another muscle group includes the hip abductors and hip external rotators. Imbalances in these muscle groups can also cause improper tracking of the patella. 

Prevention of Patellofemoral Pain Syndrome

Knee pain can be common. However, there are steps you can take to reduce the pain.

  • Keep strength. Strong quadriceps, hamstrings, hip external rotators, and hip abductor muscles help maintain a balanced knee during activity. However, you should avoid deep squatting while weight training at the beginning of the program. A good rule of thumb when progressing with strengthening within a range of motion is to track the pain intensity on a scale of 0-10. Suppose it is more than a 3/10; you probably need to decrease the range of motion, weight, reps, etc.
  • Focus on alignment and technique. Talk to your doctor or physical therapist to learn about flexibility and strength exercises that improve your jumping, running, and pivoting techniques. Training for your hip muscles is essential to keep your knees from bowing when you jump, squat, or descend from a step.
  • Warmup. Do five minutes of light exercise before running or any other activity. After the general warmup, include a dynamic warmup where the joints are taken throughout the full range of motion before the training. 
  • Mobility. Flexibility with gentle stretching exercises.
  • Maintain a steady increase in intensity. Do not make sudden changes to your training intensity.
  • Learn more about your shoes. Check that your shoes are comfortable and offer shock absorption. Consider shoe inserts if you have flat feet. Ensure the heel is not elevated, as this may increase the pressure through the anterior aspect of the knee (at least when starting a program). 

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Dr. Tyler is a physical therapist and founder Scottsdale Physical Therapy & Performance in North Scottsdale, Arizona. He see golfers,  athletes and active adults. His focus is offering one-on-one sessions for 1 hour focused on developing individualized programs to get you back to your goals.

If you have any questions about online programing or want to stop in for a visit, please reach out by hitting “request appointment” in the top of the page.

– Dr. Tyler PT, DPT, FAAOMPT, TPI-2

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