The Lister Hospital
Chelsea Bridge Road SW1W 8RH London
Patellofemoral pain syndrome
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.
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:
- X-rays
- CT scans
- MRI scans
- Ultrasound
What are the treatment options for patellofemoral pain syndrome (PFPS)?
Patellofemoral pain syndrome FAQs
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.
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.
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.
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.
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.
Why choose HCA UK for patellofemoral pain 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. 99% 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.
Our runner’s knee treatment locations
London Bridge Hospital
27 Tooley Street SE1 2PR London
The Wellington Hospital
Wellington Place St John's Wood NW8 9LE London
The Harborne Hospital
Mindelsohn Way B15 2FQ Birmingham
The Wilmslow Hospital
52-54 Alderley Road Wilmslow SK9 1NY Cheshire
The Princess Grace Hospital
42-52 Nottingham Place W1U 5NY London
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This content is intended for general information only and does not replace the need for personal advice from a qualified health professional.