Patellofemoral pain syndrome and private treatment

Patellofemoral pain syndrome (PFPS) (otherwise known as “runner’s knee”) is a common condition that causes pain at the front of the knee joint. We offer a range of effective PFPS treatments to reduce pain and discomfort.

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With HCA UK, you can get:

Appointments with knee specialists confirmed within 24 hours
Orthopaedic care that's been rated very good or excellent by 97% of our patients
A team of orthopaedic consultants who specialise in treating knee pain

What is patellofemoral pain syndrome?

Patellofemoral pain syndrome is a term used to describe pain at the front of your knee and around the kneecap (patella). Otherwise known as 'runner's knee', 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.

What causes the pain in patients with PFPS?

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.

This pain and stiffness can make it difficult to perform everyday activities, such as using stairs, kneeling and squatting. Pain can worsen after vigorous exercise like running, walking down slopes or hills or even after long periods of sitting down.

Sometimes referred to as anterior knee pain, patellofemoral pain syndrome usually responds well to management with exercise modifications and lifestyle changes. It's rare that you'll require surgery for PFPS.

What are the symptoms of patellofemoral syndrome?

The main symptom of PFPS is pain. 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. It can affect one or both knees.

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

Without the right treatment, people experiencing patellofemoral pain syndrome can develop biomechanical abnormalities of the leg. This is because you'll subconsciously try to overcompensate for the knee pain. If left untreated, runner's knee can lead to permanent damage and leave you prone to developing knee arthritis.

What causes patellofemoral syndrome?

In rare cases, PFPS can be caused by an impact injury. For most people, though, it can be difficult to pinpoint the exact cause of PFPS. It's usually a combination of factors. Some of these include:

Your kneecap being too high in the knee joint
Starting a new activity or sport
Increased intensity or frequency of an existing activity, such as running
Reduced activity levels (leading to muscle weakness)
Poor training technique or a change in training environment for example, running on different surfaces can aggravate patellofemoral pain syndrome
Muscle tightness or weakness in your hip and knee
Wearing unsupportive footwear like flat shoes or high heels
Previous injuries
Being overweight
Spending too long kneeling at work

Why does overuse cause pain?

Exercise is usually beneficial, so it can be frustrating if your knee pain is a result of increased activity. Most patients who experience patellofemoral pain do so because the body is unable to cope with the increased load. This is usually the case if patients try to do too much too soon. For the body to effectively adapt to the increase in activity without causing pain, exercise must be introduced slowly.

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.

Any increase in activity level that requires you to bend and extend your knee more than normal will increase the number of times your kneecap rubs against the already damaged soft tissue.

Unfortunately, it's not just the frequency of exercise that can exacerbate your knee pain. For example, changing your running shoes or exercising on a new surface can cause patients with patellofemoral pain syndrome even more discomfort.

How is patellofemoral pain syndrome diagnosed?

If you're experiencing knee pain and suspect you might have patellofemoral pain syndrome, book an appointment to see one of our knee specialists. Our consultants have years of experience in diagnosing and treating all kinds of knee pain.

Your consultant will have a detailed conversation with you about your medical history, lifestyle, general level of health and any activities (such as high-impact sports) you like doing. They'll then ask you about your symptoms and physically examine your knee. During this, 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:

Surgery

This is rare for patellofemoral pain syndrome but surgery can be recommended for severe cases that haven't responded well to management techniques. Surgical treatments include a knee arthroscopy or knee realignment surgery.

Knee arthroscopy: Your surgeon will insert a device with a small camera on the end, called an arthroscope, into the knee through a small incision. The arthroscope allows your surgeon 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.

What are the treatment options for patellofemoral pain syndrome (PFPS)?

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Lifestyle modifications

The management of patellofemoral pain syndrome can include your consultant recommending changes to your exercise regime. 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 spreading your activity throughout the day 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 running frequency, 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.

Your consultant might also recommend weight management. Losing weight can reduce the pressure on your knees and provide relief from the symptoms of your patellofemoral pain syndrome. Clinical trials have shown that for every pound of weight lost, four pounds of pressure is taken off the knees.

Your consultant might also advise you to change your footwear to something sturdier. Good running shoes are essential if you're suffering from patellofemoral pain syndrome.

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Orthotics

Orthotics made from viscoelastic material are recommended for those 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.

Orthotics can be custom-made or purchased 'off the shelf'. For PFPS patients, orthotic scan include splints, braces and inserts that can help align and stabilise your foot and ankle, taking the stress off your knee.

Physiotherapy

A personalised, well-structured physiotherapy programme is the go-to treatment method for patellofemoral pain syndrome.

One of our specialists will look at the root cause of your knee pain to recommend specific exercises to improve your range of movement, strength and endurance. For example, if your patellofemoral pain is due to weak quadriceps, they'll design an exercise programme that targets these muscles to address your imbalances. Other patients may have tight lateral structures or poor quadricep flexibility, both of which can be improved with certain stretches.

Your physiotherapist will provide you with exercises to undertake at home and arrange regular outpatient appointments.

Surgery

Knee arthroscopy: Your surgeon will insert a device with a small camera on the end, called an arthroscope, into the knee through a small incision. The arthroscope allows your surgeon 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.

Lifestyle modifications

Your consultant might also advise you to change your footwear to something sturdier. Good running shoes are essential if you're suffering from patellofemoral pain syndrome.

Orthotics

Physiotherapy

A personalised, well-structured physiotherapy programme is the go-to treatment method for patellofemoral pain syndrome.

Your physiotherapist will provide you with exercises to undertake at home and arrange regular outpatient appointments.

Surgery

Knee arthroscopy: Your surgeon will insert a device with a small camera on the end, called an arthroscope, into the knee through a small incision. The arthroscope allows your surgeon 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.

How to book an appointment with a knee specialist for patellofemoral pain syndrome?

If you're experiencing the symptoms of patellofemoral pain syndrome and want to understand your treatment options, our knee specialists can help. To book an appointment with a consultant, all you need to do is:

Fill in our online contact form.
Keep your GP referral letter handy if you have one. We might need this to confirm your appointment.
We'll usually be able to confirm your appointment there and then. If we can't, we'll phone or email you within 24 hours to confirm when and where you can see one of our consultants.

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Patellofemoral pain syndrome FAQs

How common is PFPS?

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 alignment factors, such as women having wider pelvises. A wider pelvis changes the angle within the knee joint, putting extra strain on the different compartments. Women also tend to have weaker quadriceps, hips and adductors.

Although patellofemoral pain syndrome is usually caused by changes in activity levels, it can affect people who don't participate in sports. In individuals who do not play sports, PFPS can be caused by muscle imbalances, trauma to the kneecap, or surgery to repair an anterior cruciate ligament. This is because the surgery to fix a torn ACL can increase flexion contracture, leading to irritation of the soft tissue around the knee. Individuals who undergo ACL surgery can also experience weak quadriceps, which can also contribute to PFPS.

Does patellofemoral pain syndrome go away?

Most people who are diagnosed with PFPS see dramatic improvements in their knee pain after making lifestyle changes and having physiotherapy. The right physiotherapy programme will target the muscles surrounding the knee joint. Strengthening the soft tissue surrounding the knee pulls the compartments of the joint back into the correct movement plane. Once the knee is tracking correctly, your symptoms usually go away.

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.

Are there any home remedies for patellofemoral pain syndrome?

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.
Medication: Over-the-counter painkillers such as paracetamol, ibuprofen or naproxen can help minimise discomfort. These are for short-term relief from patellofemoral pain syndrome symptoms and shouldn’t be taken for longer than two to three weeks.
PFPS knee brace: You might want to consider wearing a knee brace if you're suffering from patellofemoral pain syndrome. A brace provides additional support to your kneecap by compressing the patellar tendon, which can minimise pain and protect your knee from further damage. An orthopaedic knee brace can also help support your knee. Correcting the patella's position in the knee reduces soft tissue damage and allows any damaged tissue to heal properly.
Reduce activity levels: While it's not necessary to stop exercising altogether, it's a good idea to reduce the amount of exercise you're doing. You should look to avoid certain movements that put excessive pressure on the knee joint, such as lunging and deep squatting.

Can physio help with PFPS?

Physiotherapy is the main treatment method for PFPS. Our experienced team of musculoskeletal physiotherapists can assess your condition and come up with an effective PFPS knee treatment plan. Once your physio has identified what movements aggravate your knee pain, they'll devise a treatment plan.

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.

Our physiotherapists will discuss the best ways to reduce knee pain during exercise with you. If you need to rest for a little while as you recover, your physio will discuss a phased return to sport with you.

How long will it take to recover from PFPS?

Unfortunately, there isn't a quick fix for PFPS 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.

How much does treatment for patellofemoral pain syndrome cost?

How much your patellofemoral pain syndrome treatment will cost depends on the treatment recommended by your knee specialist. As treatment options range from physiotherapy to surgery in extreme cases, it's hard to say how much your treatment will cost.

Once your consultant has assessed your knee and confirmed a diagnosis, they'll be able to discuss the treatment options available and ways to pay with you.

Paying for your PFPS treatment

Why choose HCA UK for patellofemoral pain syndrome treatment?

Fast access to top-rated care: We'll confirm your appointment within 24 hours. We can usually offer same-day imaging so you can get a fast diagnosis without multiple appointments.

Leading imaging equipment: Our diagnostic centres are equipped with cutting-edge technology. This, combined with musculoskeletal radiologists who report on every scan, means we leave no stone unturned when it comes to your diagnosis.

'Outstanding' ratings: We have the highest proportion of top ratings from the Care Quality Commission of any private hospital group in the UK. When you choose HCA UK, you choose high-quality care.

We adhere to strict standards: Our knee specialists all follow the code of practice set out by the British Orthopaedic Association (BOA).

We're trusted by patients: In our latest patient survey, 97% of our orthopaedic patients rated our level of care as very good or excellent. 96% would recommend HCA UK to their family and friends too.

Book an appointment with a knee specialist

If knee pain is holding you back, don't hesitate to get in touch. We'll book you an appointment with the most suitable consultant and arrange any necessary diagnostic imaging for the same day too.

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