Have you ever felt a nagging ache in the front of your knee after a long walk or a tough workout? You might be dealing with patellofemoral pain syndrome or PFPS. You may also hear it referred to as runner’s knee, patellofemoral syndrome or retropatellar pain syndrome.
Patellofemoral pain syndrome is very common. It can affect athletes who play sports as well as people who are less active, so it’s not just limited to those involved in high intensity activities. Knee pain from PFPS can make daily activities harder, so knowing the symptoms, treatments and recovery steps is important.
What Is Patellofemoral Pain Syndrome?
Put simply, patellofemoral pain syndrome is pain at the front of the knee. It happens right around and under the kneecap, or the patella. This is the spot where your kneecap glides over your thigh bone, or the femur.
How Do You Get Runner’s Knee?
Here are some of the most common causes:
- Overuse: Doing the same motion over and over again, like running, jumping or cycling, can irritate your knee.
- Muscle imbalances: Weak thigh or hip muscles can’t support your kneecap properly, which causes problems when you bend your leg.
- Poor foot mechanics: Having flat feet or wearing the wrong shoes can alter your alignment and stress your knee.
- Sudden increases in activity: Adding too much exercise or training too quickly can trigger knee pain.
Patellofemoral Pain Syndrome Risk Factors: Who Is Most at Risk?
Below are some risk factors that make it more likely you could develop PFPS:
- Age: Teenagers and young adults are more likely to get PFPS because their bones and joints are still developing. As they become more active, their knees may be more sensitive to extra stress, which can increase the chance of pain or injury.
- Activity type: Certain activities (like running, climbing stairs, jumping and hiking) put more stress on the knee.
- Gender: Females have a slightly higher risk because of differences in hip and knee alignment that can add stress to the kneecap.
- Previous injuries: A history of knee injuries makes PFPS more likely.
- Posture and mechanics: Poor posture (like slouching or misalignment in your spine, hips or legs) and incorrect body mechanics, such as improper running form or overpronating (rolling your feet inward when you walk or run) can put extra strain on your knees and increase your risk of developing PFPS.
Symptoms of PFPS
Look for these common symptoms of patellofemoral pain syndrome:
- Dull, aching pain in the front of the knee
- Pain that gets worse when you climb stairs, squat, kneel or run
- Discomfort after sitting with bent knees for a long time (sometimes called “moviegoer’s knee”)
- Grinding, clicking or popping sounds in your knee when you move it
What Kind of Doctor Should I See for PFPS?
If your knee hurts, here’s who you can see for help:
- Primary care physician: Start by visiting your regular doctor. They can check your knee and give you an initial idea of what might be wrong.
- Sports medicine doctor: If you play sports, this type of doctor can help with activity-related injuries and give advice tailored to athletes.
- Orthopedic specialist: These doctors focus on bones and joints, making them a great choice for knee issues that need more specialized care.
- Physical therapist: Physical therapists are experts in teaching exercises to build strength and improve your leg alignment. The right therapy for patellofemoral pain syndrome can open up your treatment options and help you heal faster.
How Is Runner’s Knee Diagnosed?
A PFPS diagnosis starts with a simple physical exam. The doctor will press on different parts of your knee, move your leg around and watch how you walk.
Sometimes, they run patellofemoral pain syndrome tests like X-rays or an MRI. These pictures help the doctor look at your bones and tissues. The main goal of a knee pain evaluation is to make sure you do not have a different injury, like a torn ligament or damaged cartilage.
Can I Still Run With PFPS?
If you have mild symptoms, the answer is often yes.
However, you will likely have to make some adjustments as you heal. You can usually keep moving if you adjust how hard, how far and where you run. For example, running on soft dirt is better than running on hard concrete.
The most important rule of dealing with runner’s knee is to listen to your body. You should never try to push through sharp or significant pain. If your PFPS flares up, take a break.
Treatment of Patellofemoral Syndrome
There are many ways to make your knee feel better. The treatment of patellofemoral syndrome usually falls into two categories.
Non-Surgical Options
Most people get better without surgery.
- The best therapy for patellofemoral pain syndrome involves:
- Rest and modifying your activities to reduce stress on your knee
- Physical therapy, which teaches you how to strengthen your leg muscles and stretch tight areas
- Using ice packs can reduce swelling and provide relief
- Pain relievers (as directed by your doctor or parent) can help with discomfort
- Supportive devices, such as:
- Knee braces
- Special athletic tape
- Shoe inserts or orthotics are also great treatment options that take the pressure off your knee
Surgical Considerations
Surgery is reserved for the most severe, long-lasting cases that haven’t improved in other ways. In rare cases where surgery is considered, several procedures may be recommended depending on your specific knee problem:
- Arthroscopy: A minimally invasive surgery using a small camera to look inside your knee and treat cartilage damage or other issues that might be causing your pain.
- Lateral release: This procedure cuts tight ligaments on the outer side of your kneecap to help improve how your kneecap moves and relieve discomfort.
- Realignment surgery: For people whose kneecap is out of alignment, surgeons may reposition it so that it glides more smoothly and reduces stress.
- Cartilage restoration procedures: If damaged cartilage is causing pain, options like microfracture surgery (to encourage new cartilage growth) or a cartilage graft can be used to repair the joint surface.
- Patellar tendon surgery: In rare situations where the tendon under your kneecap is badly damaged, surgical repair may be necessary.
If your doctor suggests surgery, be sure to discuss these options carefully with your healthcare provider so you understand the risks, benefits and what to expect from each procedure.
Recovery Time
Healing from PFPS takes patience, but most people feel better within a few weeks to a few months when they follow their treatment plan.
Recovery depends on factors like your age, activity level and how severe your symptoms are. Listening to your body and following your treatment plan can help you recover well. If your pain continues or gets worse, let your healthcare provider know.
Exercises & Home Remedies
- Movement is medicine. Doing the right PFPS exercises can speed up your healing.
- Focus on strengthening the muscles around your knee and hips.
- Building strong quadriceps and glutes helps keep your kneecap in the perfect spot.
- Add patellofemoral syndrome stretches to your routine:
- Stretch your hamstrings
- Stretch your calves
- Stretch the side of your leg (like your IT band)
- Try foam rolling to help with knee strengthening and mobility.
- Always do a proper warm-up before exercising.
Prevention Tips
Here are some tips to help prevent PFPS before it starts:
- Increase your exercise levels gradually. Avoid sudden large jumps in distance or intensity.
- Do regular knee and leg strengthening exercises to keep your muscles strong.
- Wear supportive shoes that fit well and help your feet align properly.
- Mix up your workouts with cross-training — try activities like swimming or yoga instead of running every day.
- Make knee-strengthening exercises a part of your weekly routine to help prevent extra strain on your joints.
FAQs
Do you only get runner’s knee from running?
No. Anyone who bends their knees frequently or has weak leg muscles can get it.
Can I still run with PFPS?
Yes, but you need to lower your distance and stop if it hurts.
Do you need surgery for PFPS?
Surgery is very rare. Most people heal with rest and physical therapy.
Can PFPS become chronic?
Yes. If you ignore the pain, you can develop chronic runner’s knee.
How long does it take to recover?
Your recovery time can range from a few weeks to a few months, depending on how quickly you start treating it.
Is an ACL tear or a patellar tear worse than PFPS?
Yes, both ACL tears and patellar tears are typically more serious than PFPS. They usually require longer recovery times and may need surgery, while PFPS is usually manageable without surgery.
What is the difference between PFPS and patellar tendonitis?
Patellar tendonitis (jumper’s knee) means the tendon just below your kneecap is inflamed, often because of overuse. PFPS, on the other hand, is pain at the front of the knee, usually under or around the kneecap, and isn’t always caused by inflammation of the tendon.
Do I need special tests to know if I have PFPS or another knee problem?
Sometimes. A doctor will start with a physical exam and may order imaging tests like X-rays or an MRI to make sure your pain isn’t from another injury, like a torn ligament or cartilage. This helps make sure you get the right treatment.
Patellofemoral pain syndrome is a very common issue, but it is entirely manageable. Getting your knee checked early gives you the best chance for a quick recovery. Remember, most cases of PFPS improve simply with rest and non-surgical treatment options. Take care of your body, remember to do your exercises and always ask a professional for help if your runner’s knee continues for an extended period of time.
At Stony Brook Orthopaedic Associates – Division of Sports Medicine, we provide comprehensive care for athletes of all ages and skill levels. Our fellowship-trained physicians specialize in injuries to the shoulder, elbow, knee, foot and ankle, using the latest minimally invasive, arthroscopic and biologic treatments. Working closely with athletic trainers, physical therapists and other providers, our goal is to keep you safe, active and performing at your best.
Whether you’re recovering from an injury, managing a chronic condition, or looking to optimize your athletic performance, our team is here to help. Call (631) 444-4233 to learn more or schedule an appointment.
