Knee

What It Is

Patellofemoral pain syndrome (PFPS) is pain at the front of the knee, around and behind the kneecap. It is common in people who play sports, such as runners, jumpers, cyclists, skiers and football players, but it also happens in people who are not athletes (AAOS, n.d.; St George's University Hospitals NHS Foundation Trust, 2026).

Many factors can contribute to this condition. These include overuse, sudden increases in activity, unsupportive footwear, problems with the alignment of the kneecap, and weakness, tightness or imbalance in the thigh and hip muscles (AAOS, n.d.; St George's University Hospitals NHS Foundation Trust, 2026). A less common cause is an injury such as a fall onto the knee (St George's University Hospitals NHS Foundation Trust, 2026).

PFPS can come from irritation of the soft tissues around the front of the knee. Other factors include poor training technique or equipment, changes in footwear or playing surface, and muscle imbalance (AAOS, n.d.).

PFPS is sometimes called "runner's knee" (AAOS, n.d.). It is different from iliotibial band syndrome, which causes pain on the outside of the knee. PFPS can cover a range of problems, but they all tend to cause pain at the front of the knee.

PFPS is typically an overuse condition, with people noticing the pain after doing too much, or after a sudden change in how often, how long or how hard they train (AAOS, n.d.). It may affect long-distance cyclists, or runners who regularly overload their body.

Patellofemoral Pain Syndrome Anatomy

There are lots of structures around the front of the knee that can cause pain. One of the most common sources is the area around the patella (kneecap). The main muscles in the thigh, known as the quadriceps, connect into the kneecap through the quadriceps tendon. There is also a strong tendon below the kneecap, the patellar tendon, which attaches to the tibia (the shin bone). Around the kneecap is a sheath known as the patellar retinaculum, which helps to keep the kneecap stable. Just below the kneecap is a small pad of fat, and the joint is lined by a thin tissue called the synovium; these soft tissues can become irritated and painful (AAOS, n.d.).

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

Treatment

Self-Care & Treatment

How to Treat Patellofemoral Pain Syndrome

Exercises that strengthen the thigh (quadriceps) and hip muscles are the main recommended treatment, and hands-on treatment works best alongside exercise rather than instead of it (Crossley et al., 2016; St George's University Hospitals NHS Foundation Trust, 2026). I can guide you through a strengthening programme, with exercises such as bridges, wall squats and sit-to-stands, alongside soft tissue work for the thigh and hip. See the My Approach tab for how I work.

1. Ice

Ice can help with short-term pain relief. Wrap an ice pack (or a bag of frozen vegetables) in a tea towel and place it over the painful area for up to 15 minutes. This can be repeated up to four times a day (St George's University Hospitals NHS Foundation Trust, 2026). Never put ice directly on the skin, as this can cause an ice burn.

2. Rest and Recover

Cut back on the activities that are very painful for a short time to let the pain settle, then slowly increase your activity again once the pain is at a level you can manage (St George's University Hospitals NHS Foundation Trust, 2026). Some athletes switch to low-impact activities while the knee settles. Swimming or riding a stationary bike can help offload the knee (AAOS, n.d.).

3. Compression

Lightly wrapping the knee in an elastic bandage, leaving a hole for the kneecap, can help prevent extra swelling (AAOS, n.d.). Make sure the bandage fits snugly without causing extra pain.

Tips

Stay in shape. Good general fitness helps to prevent and control pain around the kneecap. If you are overweight, losing weight will reduce the pressure on your knees (AAOS, n.d.).
Avoid any sudden changes in exercise intensity. Increase activity gradually (AAOS, n.d.).
Wear supportive shoes that suit your sport. Make sure they fit properly and are in good condition (AAOS, n.d.; St George's University Hospitals NHS Foundation Trust, 2026).
Warm up thoroughly before running or any other exercise, and include stretches for the front and back of the thigh in your warm-up and after activity (AAOS, n.d.).
Use proper form when running. Seek advice from a coach to make sure your technique is good.
Be patient: symptoms can take between three and six months to improve (St George's University Hospitals NHS Foundation Trust, 2026).

Treatment

My Approach

Line drawing of the front of the thigh from the side, showing the quadriceps muscles running from the hip and thigh bone down to the kneecap. — Four muscles, one kneecap — when one side of the quads pulls harder than the others, the kneecap feels it.

Pain at the front of the knee is rarely just a knee problem. Weak thigh and hip muscles, tight calves, a sudden jump in training and feet that roll inward can all add load around the kneecap. My aim is to settle the pain, then build strength in your thigh and hip so your knee copes with stairs, running and sport again.

I start by assessing how your whole leg lines up and moves, from your hip down to your foot, as you squat, step down and walk or run. I also test your strength and flexibility and ask about your training and footwear.

When It's Sore

Cutting back stairs, deep squatting and other activities that flare it, and swapping running or jumping for swimming or easy cycling for a while
Massage, trigger point and myofascial work for the thigh, hamstrings, calf and hip
Work on the buttock muscles only with your informed consent and a written consent form
Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
Taping to take some load off the kneecap in the short term, and I'll show you how to tape it yourself

Strength and Loading

Thigh tightening, bridges and side-lying hip work, building to wall squats, sit-to-stands and slow step-downs, with your knee lined up over the middle of your foot
Some discomfort while you exercise is fine, but if the pain is worse for more than 24 hours afterwards, we do less next time
Stretches for the front and back of the thigh and the calf
A home programme between visits and, when you're ready, gym-based strength work and a graded return to running or sport

If your feet roll in a lot, I'll help you work out whether an insole might help and how to get one, and point you to a chiropodist or podiatrist if you need a custom orthotic.

If your knee swells a lot, locks or gives way, 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 you manage more on your own. Expect improvement to take about three to six months.

What I Focus On

Whole-Leg Assessment

Thigh & Hip Release

Hip & Quad Strength

Load Management

Taping & Footwear

Sources

References

American Academy of Orthopaedic Surgeons (AAOS) (n.d.) Patellofemoral pain syndrome. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/ (Accessed: 7 October 2026).
St George's University Hospitals NHS Foundation Trust (2026) Patello-femoral pain (PFP). Available at: https://www.stgeorges.nhs.uk/wp-content/uploads/2023/11/CSW_PFP_03.pdf (Accessed: 7 October 2026).
Crossley, K.M., van Middelkoop, M., Callaghan, M.J. et al. (2016) '2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions)', British Journal of Sports Medicine, 50(14), pp. 844–852. doi: 10.1136/bjsports-2016-096268

Massage therapy · Kitchener–WaterlooPatellofemoral Pain Syndrome

What It Is

Patellofemoral Pain Syndrome Anatomy

Self-Care & Treatment

How to Treat Patellofemoral Pain Syndrome

1. Ice

2. Rest and Recover

3. Compression

Tips

My Approach

When It's Sore

Strength and Loading

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooPatellofemoral Pain Syndrome

What It Is

Patellofemoral Pain Syndrome Anatomy

Self-Care & Treatment

How to Treat Patellofemoral Pain Syndrome

1. Ice

2. Rest and Recover

3. Compression

Tips

My Approach

When It's Sore

Strength and Loading

Typical Course

References

Related Conditions

Iliotibial Band Friction Syndrome

Patellar Tendinopathy

Hyperlordosis

Flat Foot (Pes Planus)

Chondromalacia Patella

Book a session