What are the signs and symptoms of patellofemoral pain syndrome (PFPS)?

From the Guidelines

Patellofemoral pain syndrome (PFPS) typically presents with pain around or behind the kneecap that worsens with activities that load the patellofemoral joint, such as climbing stairs, squatting, running, jumping, or sitting with the knee bent for prolonged periods. The most common symptoms include:

• Dull, aching pain in the front of the knee
• Grinding or crepitus sensation when bending or straightening the knee
• Feeling of the knee "giving way" due to reflex inhibition of the quadriceps muscle
• Swelling around the knee, usually minimal
• Difficulty with daily activities like kneeling
• Pain worsening after periods of inactivity The condition typically develops gradually rather than from a single traumatic event, and physical examination may reveal tenderness along the edges of the patella, pain with compression of the patella against the femur, and occasionally abnormal patellar tracking during knee movement, as noted in a study published in the British Journal of Sports Medicine 1. PFPS results from improper tracking of the patella in the femoral groove, often due to muscle imbalances, overuse, biomechanical issues like excessive pronation of the foot, or anatomical factors such as a shallow trochlear groove or patella alta, as supported by expert opinions and patient interviews 1. The condition affects women more frequently than men, particularly active young adults and adolescents, and has a significant impact on quality of life, with over 50% of people reporting persistent pain more than 5 years post-diagnosis despite receiving treatment, as reported in a study published in 2024 1. Education and knee-targeted exercise therapy are essential components of management, with a focus on hip and knee strengthening, as well as addressing biomechanical and anatomical factors, as recommended by experts and supported by patient experiences 1.

From the Research

Signs and Symptoms of Patellofemoral Knee Syndrome

• Patellofemoral pain syndrome (PFPS) is characterized by pain behind or around the patella and crepitations, provoked by activities such as:
  • Ascending or descending stairs
  • Squatting
  • Prolonged sitting with flexed knees
  • Running
  • Cycling 2
• The symptoms of PFPS impede function in daily activities or sports 2
• Knee pain is located in the anterior aspect (front) and retropatellar region (behind) of the knee joint 3
• PFPS is a painful musculoskeletal condition that affects adolescents and young adults 2

Treatment and Management

• Strength training and stretching exercises are effective treatment options for runners with PFPS 4
• Quadriceps and hip strengthening combined with stretching in a structured physiotherapy program comprise the most effective treatment for reducing knee pain symptoms and improving functionality in patients with PFPS 4
• Therapies such as proprioceptive training, orthotics, and taping may offer benefits as adjunctive therapies but do not show a significant benefit when used alone in patients with PFPS 4
• Taping and bracing have been found to be helpful for patients in the short-term management of pain and improving function, but their exact mechanism is not well understood 5
• Injections, such as platelet-rich plasma (PRP), sclerosing, high volume, or stem cell injections, are being investigated as a treatment for patellar tendinopathy, but evidence is limited and more well-designed studies are needed 5