Patellar femoral pain syndrome (PFPS)
PFPS is a common condition which can affect women more than men. It is more common in younger people who are physically active.
Causes of PFPS
- PFPS is a pressure problem related to load across the knee joint between the patella (knee cap) and the femur as shown in the diagram. Treatment is directed at changing the pressure in the joint through activation of muscles and stretches.
- PFPS can be a related to a change in load such as starting a new activity, sudden increase in activity/frequency, when our tissues have not had time to adapt to the new load.
Symptoms of PFPS
Common symptoms include:
- Pain over the front of the knee around the patella. It tends to come on gradually and is dull/aching.
- Pain with squatting, stair climbing, prolonged sitting or running/jumping.
- Pain associated with clicking in the knee.
Diagnosis of PFPS
PFPS is diagnosed by a clinical assessment of the joint. An x-ray or MRI scan is not routinely required to make a diagnosis.
Self management of PFPS
Load management
Review the amount of activity you are doing and if pain corresponds to an increase in activity then reduce to a manageable level. Try to keep fit trying other activities e.g. swimming, cycling, gym exercises which do not aggravate symptoms.
Weight management
If you are overweight you are putting extra load through your knee. This will be contributing to your condition. Therefore, losing weight will improve your symptoms.
The NHS website has some useful resources:
Exercises
Muscle stretching and strengthening exercises can help to alter the pressure around the knee.
Footwear
Try wearing footwear that gives more cushioning. There is some evidence that taping and use of temporary foot orthotics (inserts) can help.
Pain relief
Using over the counter medication to help pain relief.
Exercises for PFPS
Exercise 1: quadriceps stretch
- Lying on side, bottom knee bent up level with hips
- Tighten abdominals, and flatten back
- Hold top ankle so that heel is touching buttock
- Pull top leg back behind you until good stretch is felt in front of thigh
- Keep knee lower than hip and back flat
- Hold 30 seconds x 3
Exercise 2: forward lunge
- In standing
- Step forwards with your left leg
- Lunge down with your right knee
- Bending your right knee towards the floor
- Repeat
Exercise 3: hip abduction in standing
- Stand sideways
- Make sure you are supported
- Keep your knee straight
- Take your leg out to the side
- Repeat
Exercise 4: bridge
- Lie face up on the floor, with your knees bent and feet flat on the ground
- Keep your arms at your side with your palms down
- Lift your hips off the ground until your knees, hips and shoulders form a straight line
- Squeeze your buttocks
- Hold your bridged position for a couple of seconds before easing back down
Exercise 5: clam (lateral hip rotation in side lying)
- Lying on your left side with your hips and knees bent
- Lift your right knee up and rotate your hip
- Forming a gap between your knees
- Repeat
What next?
If you are still experiencing symptoms despite following the above advice, it is important you seek advice from your GP. Your GP may decide to refer you to the musculoskeletal clinic or to a physiotherapist.
Page updated 01/12/2020. Review date 01/01/2024
