What is Patellofemoral joint pain?

Patellofemoral pain (PFP), is a condition that causes pain around the front of the knee, particularly where the kneecap (patella) meets the thigh bone (femur), however, it can be felt at the sides or even back of the knee in some cases. It is often due to overuse, muscular imbalances, or improper knee or kneecap alignment, leading to irritation of the joint structures. PFP is different to patella tendinopathy, also known as jumper’s knee, in that the forces required to bring on the pain and dysfunction are a lot higher and a lot more specific. While pain may be felt around the patella tendon (the tendon connecting your kneecap to your shin bone) with PFP, this is not the same as a true patella tendinopathy.

Who is likely to be affected?

Adolescents, particularly those who are physically active, are more likely to develop PFP. It is more common in females due to anatomical differences such as wider hips, which can alter knee alignment. Rapid growth spurts during puberty may also contribute, as muscles and bones develop at different rates, leading to imbalances that put extra stress on the knee. Further, returning to sport or activity after a break (such as the school holidays), or starting a new sport or activity may bring on these pains in our younger populations.

While younger persons (28.9%) can get this type of knee pain from their ever-changing schedules, adults are just as likely to fall victim to this annoyance (general population data 22.7%). PFJP has been known to recur after two years in 40% of cases.

What activities may cause aggravation? 

Patellofemoral Pain (PFP) is an overuse type pain that is diffuse around the knee. While adolescent females are more susceptible, anyone at any age can get it. Repetitive or high loading tasks may increase the discomfort. A Physiotherapist can assist with accurate diagnosis, education and rehabilitative exercises to strengthen weak muscles and reduce aggravating factors.

PFP is often worsened by activities that place repetitive or prolonged strain on the knee joint. Common aggravating factors include:

· Running, especially on hard surfaces or uneven terrain

· Jumping and landing activities such as basketball or volleyball

· Squatting or kneeling for extended periods

· Climbing stairs or hills

· Prolonged sitting with bent knees (desk work)

Can it be managed with a physiotherapist?

Early intervention, education and proper rehabilitation can significantly improve symptoms. A physiotherapist can help manage PFP through a combination of:

· Strengthening exercises to improve muscle balance, especially in the quadriceps, glutes, and core

· Stretching routines to enhance flexibility and reduce tension around the knee

· Manual therapy to address tight or weak muscles

· Pain management such as icing may assist with local flare ups after activity

· Taping or bracing for improved knee and patella tracking

· Biomechanical assessment to modify running or movement patterns

About the author

Kelsey Thomas is a physiotherapist, dance program coordinator and myotherapy team lead. While sport is her passion, Kelsey believes that creating solid foundations of strength and rehabilitation are key components in maintaining a healthy lifestyle, whether you work in an office or as an elite athlete. “Having participated in a fair few sports over the years it’s given me a better understanding of the demands the body can be put through, the movements required to succeed and the difficult task of taking time away from the sport you love when injured.”

Kelsey employs a hands-on approach when treating muscular pains and joint dysfunction, complementing treatment outcomes with modalities such as cupping, dry needling, trigger point therapy, and taping. “Shoulder joint issues really fascinate me because they can be unpredictable and complex. I really enjoy the process of breaking down why the injury has occurred in the first place and rehabilitating the joint structures.”

References

Smith, B. E., Selfe, J., Thacker, D., Hendrick, P., Bateman, M., Moffatt, F., Rathleff, M. S., Smith, T. O., & Logan, P. (2018). Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PloS one, 13(1), e0190892. https://doi.org/10.1371/journal.pone.0190892

Winters, M., Holden, S., Lura, C. B., Welton, N. J., Caldwell, D. M., Vicenzino, B. T., … & Rathleff, M. S. (2021). Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis. British journal of sports medicine, 55(7), 369-377.