Patellofemoral pain: pain at the front of the knee
Patellofemoral pain syndrome is the most common cause of pain at the front of the knee, particularly in runners, active teenagers and young women. The pain comes from the joint between the kneecap and the thigh bone when it is overloaded, and in the vast majority of cases it is treated without surgery.
Typical symptoms
pain around or behind the kneecap;
pain going up and, especially, down stairs;
pain when squatting, running downhill or after sitting for a long time with your knees bent;
clicking when bending the knee, usually harmless.
Why it happens
A rapid increase in load: more kilometres, more hills or more squats than the knee is ready to handle.
Hip and knee control: when the knee "caves in" on landing (dynamic valgus), the kneecap tracks poorly and pressure increases.
Weakness of the quadriceps and hip muscles.
Anatomical factors: the shape or position of the kneecap may contribute in some people.
Other causes of pain at the front of the knee
Not all pain around the kneecap is patellofemoral pain. Patellar tendinopathy hurts at a precise point just below the kneecap and is typical in jumping sports (volleyball, basketball). Osgood-Schlatter disease causes pain and a bump below the knee in growing teenagers. A meniscus injury usually hurts along the joint line, at the side, and can cause locking. And in older people, pain climbing stairs may be osteoarthritis of the patellofemoral joint. Telling these causes apart changes the treatment, so a clinical examination is the first step.
When to see a doctor
A swollen, warm or locking knee.
A feeling that the knee "gives way" or the kneecap slips out of place.
Pain after a fall or a twist.
Pain that doesn't improve after a few weeks of reduced load and exercise.
How we diagnose it
The diagnosis is clinical: the history and a knee examination are enough in most cases. At Clínica Myalgia we add a movement analysis, which shows whether the knee loses alignment when squatting, jumping or running. Imaging is only requested when another injury is suspected.
Treatment
Adjust load: temporarily cut back on what hurts most, without stopping all activity.
Physiotherapy with exercise: strengthening the quadriceps and hip muscles is the treatment with the strongest evidence.
Movement training: correcting dynamic valgus when squatting, jumping and running.
Made-to-measure insoles: useful in the short term for people whose foot rolls inwards.
A gradual return to running or sport, with a week-by-week plan.
Find out more about other causes in knee pain.
Exercises we often use
Hip: side-lying leg raises, glute bridges and lateral band walks, to control thigh rotation.
Quadriceps: knee extensions in a comfortable range, partial squats and step-ups, increasing the load gradually.
Movement control: single-leg squats in front of a mirror, keeping the knee in line with the foot.
Mild pain during exercise (up to 3 on a scale of 0 to 10) is acceptable, as long as it doesn't increase the next day.
How to prevent it
Increase running or training volume gradually.
Do strength training for the legs and hips twice a week.
Be careful with long descents and sessions with lots of jumping, which load the kneecap more.
For athletes with recurring pain, have a biomechanical analysis.
Frequently asked questions about patellofemoral pain
Is clicking in the knee serious?
In most cases, no. Clicking without pain or swelling is common and needs no treatment.
Can I keep running?
Often yes, by reducing volume and downhills and avoiding running with pain that increases during the session. The return plan is adjusted to how the knee responds.
How long does recovery take?
With well-targeted exercise, most people improve over six to twelve weeks.
Do I need surgery?
Rarely. Surgery is only considered in cases with significant anatomical changes that don't respond to well-delivered conservative treatment.
Dr. Miguel Reis e Silva
Doctor at Sport Lisboa e Benfica
Medical Director and Founder of Clínica Myalgia
For more information or to book, please contact us using the form below.