Knee

What It Is

Osteoarthritis is a common problem, and the risk of developing it increases as you get older (NHS, 2023a). Osteoarthritis is sometimes referred to as degenerative, or "wear and tear", arthritis. It may result from an injury to the knee earlier in life (NHS, 2023a).

Fractures involving the joint surfaces, instability from ligament tears, and meniscal (knee cartilage) injuries can all cause abnormal wear and tear of the knee joint. Not all cases of osteoarthritis are related to a previous injury, however. Osteoarthritis can run in families, and being overweight also increases the risk (NHS, 2023a).

Patellofemoral (sometimes called patellar-femoral) osteoarthritis is arthritis under the kneecap (patella). It affects the cartilage on the underside of the kneecap and the groove in the thighbone that the kneecap rests in (AAOS, n.d.). The kneecap can rub against the thigh bone, causing wear, or there can be damage to the cartilage underneath the kneecap. Sometimes years of the kneecap not tracking properly in its groove (maltracking) can also cause the problem.

The symptoms can be similar to other causes of pain at the front of the knee, such as chondromalacia patellae (softening of the cartilage under the kneecap). The main symptom is pain at the front of the knee, behind the kneecap. It is usually brought on by activities that put pressure on the kneecap, such as kneeling, squatting and going up or down stairs. You may also notice a crackling or grinding feeling when you move your knee (crepitus), and when the condition is advanced the kneecap may catch when you straighten your knee (AAOS, n.d.). On X-ray, the space between the kneecap and thighbone may look narrower, and bony growths (bone spurs) may develop (AAOS, n.d.).

The patella is a small bone located at the front of the knee joint, where the shinbone and the thighbone meet. It protects the knee and connects the muscles at the front of the thigh to the shinbone (tibia) (AAOS, n.d.).

Dysplasia (a shape problem) or maltracking happens when the kneecap doesn't fit properly into the groove at the end of the thighbone (the trochlear groove). Because of this, whenever the knee moves, there is more stress on the cartilage, which causes it to wear down. Another cause is a kneecap fracture, which often damages the cartilage covering the underside of the bone. Even though the bone heals, the joint surface may not be as smooth, and the friction can lead to arthritis later on (AAOS, n.d.).

Patellofemoral Osteoarthritis Anatomy

The knee is one of the biggest and most complex joints in the body. It joins the shin bone (tibia) and the thigh bone (femur) together, with the kneecap (patella) at the front (AAOS, n.d.). Tendons connect the leg muscles to the knee bones so that the knee joint can move. Ligaments join the knee bones together and give the knee stability.

The kneecap has two surfaces (facets) on its underside, a medial (inner) facet and a lateral (outer) facet, and these glide against the femur. The kneecap is a sesamoid bone (a bone that sits within a tendon). It improves the leverage of your leg muscles, making them more powerful, especially the quadriceps muscles at the front of the thigh.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Patellofemoral Osteoarthritis

Manual (hands-on) therapy cannot reverse the arthritic changes under the kneecap, and UK guidance says it should only be used alongside an exercise programme (NICE, 2022). I can combine hands-on treatment with exercises to improve how your knee and kneecap move and to strengthen your quadriceps, which can take some of the load off the kneecap (AAOS, n.d.). See the My Approach tab for how I work.

1. Anti-Inflammatory Medicines

The NHS says anti-inflammatory creams or gels (topical non-steroidal anti-inflammatory drugs, or NSAIDs) can be particularly effective for osteoarthritis of the knee, and some are available without a prescription. Anti-inflammatory tablets may be needed if creams or gels don't ease the pain, but they are not suitable for everyone, so your family doctor or nurse practitioner will discuss the benefits and risks with you (NHS, 2023b). (This medicine information comes from the NHS, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

2. Modification of Activities

In many cases, avoiding the activities that bring on your symptoms, such as climbing stairs, can help to relieve pain (AAOS, n.d.).

3. Exercise

Regular exercise is one of the most important treatments for osteoarthritis (NHS, 2023b). It can decrease stiffness and strengthen the muscles that support the knee. If you have this condition, try to avoid activities that put stress on the front of the knee, such as squatting. If you regularly do high-impact exercise, switching to low-impact activities will put less stress on the knee. Swimming and walking are both good low-impact options (AAOS, n.d.).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Steroid (cortisone) injection: a strong anti-inflammatory medicine injected into the knee joint. UK guidance says it gives only short-term relief (NICE, 2022).

How I can help (see the My Approach tab)

Hands-on treatment for the knee, thigh and hip

Exercises to strengthen your thigh and hip muscles

Advice on pacing your activities and taping

Tips

If you are overweight, losing just a few pounds can make a big difference to the amount of stress placed on the knee (AAOS, n.d.).
Physical therapy exercises, which I can guide you through, can help to improve movement in the knee, strengthen the quadriceps and take some of the load off the kneecap (AAOS, n.d.).
Consider changing your exercise routine to one that puts less pressure on the knee.

Treatment

My Approach

Patellofemoral osteoarthritis is a long-term condition, so I treat it as ongoing care. Hands-on work can't reverse the changes under the kneecap, but alongside exercise it can help ease pain and stiffness. My aim is to settle the knee, keep it moving, and build thigh and hip strength so the kneecap carries less load.

I start by assessing how your knee and kneecap move, the strength of your thigh and hip, and how you manage stairs and chairs. How hard we work depends on how irritable the knee is that day: a flared, swollen knee is kept comfortable, and a calmer, stiff knee is mobilised and loaded.

Hands-On Treatment

Massage, trigger point and myofascial work for the thigh, hamstrings, calf and hip
Gentle mobilisation of the kneecap and knee within comfort, never forced at the ends of range
Warm applications for a stiff knee when it isn't inflamed, cool applications in the clinic when it's flared, and I'll show you how to use ice safely at home
Work on the hip and buttock muscles only with your informed consent and a written consent form

Strength and Movement

Thigh tightening and straight-leg raises, then sit-to-stands from a higher chair and step-ups on a low step, kept pain-free during and after
Bridges and side-lying hip work to help control how your knee lines up
Low-impact fitness like swimming, walking or cycling
A home programme between visits and, if you lift, gym-based strength work in ranges that keep load off the front of the knee

Day to Day

Cutting back the activities that flare it, such as kneeling, deep squatting and lots of stairs, rather than stopping everything
Pacing your day and avoiding low, deep chairs
Taping to take some load off the kneecap in the short term, and I'll show you how to tape it yourself

If your knee becomes hot and very swollen, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Early on, most people come once or twice a week, then weekly, with a reassessment at about 4 to 6 weeks, then less often as your home programme takes over. With regular exercise, most people notice less pain and easier movement over about 6 to 12 weeks.

What I Focus On

Assessment

Thigh & Hip Release

Gentle Kneecap Mobility

Pain-Free Quad & Hip Strength

Activity Pacing

Sources

References

American Academy of Orthopaedic Surgeons (AAOS) (n.d.) Patellofemoral arthritis. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-arthritis/ (Accessed: 7 October 2026).
National Institute for Health and Care Excellence (NICE) (2022) Osteoarthritis in over 16s: diagnosis and management (NG226) – Recommendations. Available at: https://www.nice.org.uk/guidance/ng226/chapter/Recommendations (Accessed: 7 October 2026).
NHS (2023a) Osteoarthritis. Available at: https://www.nhs.uk/conditions/osteoarthritis/ (Accessed: 7 October 2026).
NHS (2023b) Osteoarthritis – Treatment. Available at: https://www.nhs.uk/conditions/osteoarthritis/treatment/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooPatellofemoral Osteoarthritis

What It Is

Patellofemoral Osteoarthritis Anatomy

Self-Care & Treatment

How to Treat Patellofemoral Osteoarthritis

1. Anti-Inflammatory Medicines

2. Modification of Activities

3. Exercise

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Strength and Movement

Day to Day

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooPatellofemoral Osteoarthritis

What It Is

Patellofemoral Osteoarthritis Anatomy

Self-Care & Treatment

How to Treat Patellofemoral Osteoarthritis

1. Anti-Inflammatory Medicines

2. Modification of Activities

3. Exercise

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Strength and Movement

Day to Day

Typical Course

References

Related Conditions

Anterior Cruciate Ligament (ACL) Injuries

Chondromalacia Patella

Degenerative Joint Disease

Fat Pad Impingement

Book a session