Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS), also known as runner's knee, is a common cause of front-of-knee pain that occurs when the kneecap (patella) doesn't track properly in the groove of the thighbone (femur) during movement. This improper tracking causes friction and irritation, leading to pain around or behind the kneecap.

PFPS is particularly common in athletes and active individuals, especially those who participate in running, jumping, or activities that involve repetitive knee bending. The condition can result from muscle imbalances, structural issues, overuse, or improper biomechanics during movement.

At Mountain Spine & Orthopedics, our sports medicine specialists use comprehensive evaluation including physical examination and imaging to identify the cause of patellofemoral pain and create a personalized treatment plan focused on correcting biomechanics and restoring pain-free function.

• Front-of-knee pain around or behind the kneecap
• Pain that worsens with activities like running, jumping, climbing stairs, or squatting
• Pain after prolonged sitting (theater sign)
• A grinding or popping sensation when bending or straightening the knee
• Swelling around the kneecap (in some cases)
• Stiffness, especially after periods of inactivity
• Pain that may be described as aching or sharp, depending on activity

Several factors increase the risk of developing patellofemoral pain syndrome:

• Participation in running, jumping, or high-impact sports
• Muscle imbalances, particularly weak quadriceps or tight hamstrings
• Structural issues, such as flat feet or high arches
• Improper biomechanics during running or jumping
• Overuse or sudden increases in activity intensity
• Previous knee injuries that may have altered mechanics
• Certain anatomical factors, such as a shallow patellar groove

Diagnosis begins with a comprehensive physical examination to assess kneecap alignment, muscle strength, flexibility, and movement patterns. Our specialists evaluate for signs of muscle imbalances, structural issues, and biomechanical problems that may contribute to the condition.

While diagnosis is often clinical, we may use X-rays to assess kneecap alignment and rule out other conditions. In some cases, MRI review may be ordered to evaluate cartilage health or identify other structural issues. CT scans may be used in complex cases to assess patellar tracking.

Non-Surgical Treatment Options

Initial treatment focuses on physical therapy referrals to strengthen the quadriceps muscles (particularly the vastus medialis), improve flexibility, and correct biomechanical issues. Activity modification to reduce stress on the kneecap is also important.

Injection or Interventional Care

For patients with persistent pain, corticosteroid injections may provide temporary relief. Biologic injections like PRP may also be considered in some cases to help reduce inflammation and promote healing.

Surgical Treatment Options

Surgery is rarely needed for patellofemoral pain syndrome and is typically reserved for cases with significant structural issues or when conservative treatment fails. Procedures may include arthroscopic procedures to address cartilage damage or realignment procedures to correct patellar tracking, performed using minimally invasive techniques.

Patellofemoral pain is typically felt in the front of the knee, around or behind the kneecap. The pain is often described as a dull ache that worsens with activities that stress the patellofemoral joint, such as running, jumping, or climbing stairs.

Many patients experience the 'theater sign'—pain that develops after prolonged sitting with the knee bent, which improves when the knee is straightened. The pain is often worse going down stairs than up, as descending places more stress on the patellofemoral joint. Our comprehensive treatment approach addresses both the biomechanical cause and any associated inflammation, providing lasting relief.

Several strategies can help prevent patellofemoral pain syndrome:

• Maintaining strong quadriceps muscles, particularly the vastus medialis
• Improving flexibility in the hamstrings, calves, and IT band
• Using proper running and jumping techniques
• Gradually increasing activity intensity to avoid overuse
• Wearing appropriate footwear and using orthotics if needed
• Addressing muscle imbalances through targeted exercise
• Seeking early evaluation from a sports medicine specialist when symptoms first appear

If you're experiencing front-of-knee pain that may be patellofemoral pain syndrome, schedule a consultation with Mountain Spine & Orthopedics today. Benefit from expert evaluation and personalized treatment to resolve your knee pain. Same-day and next-day appointments are often available.