What’s That Pain Under My Kneecap? Understanding Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome

That dull, achy, throbbing, sometimes-sharp pain around the knee or kneecap that comes-and-goes based on activity might be a condition known as Patellofemoral Pain Syndrome. Sometimes associated with cracking and popping, patellofemoral pain can range from not-so-bad to debilitating discomfort that causes people of all ages to avoid activities like walking, jogging, or participating in a sport. 

What causes Patellofemoral Pain?

In Patellofemoral Pain Syndrome, the discomfort in or around the front of the knee is often due to irritation of the cartilage that lines the underside of the kneecap within the joint.  Stress on the knee can cause the cartilage to become inflamed, eventually resulting in thinning and fraying of the tissue over time. In some cases, athletes start to notice symptoms after years of competition and training, even without a direct injury. In other cases, people report this pain only days, weeks, or months after an increase or change in activity. If not treated, the causes of patellofemoral pain syndrome can eventually lead to tissue degeneration in the knee, like osteoarthritis. 

The patella, or kneecap, is a floating bone connected to the femur and tibia by tendons and ligaments. The underside, or posterior aspect, of the patella is covered with a layer of cartilage, allowing it to glide smoothly over the femur when you bend and straighten your knee.  There should be adequate joint space between the patella and underlying femur, although sometimes this joint space narrows, causing increased likelihood of contact or friction between the bony surfaces.

A variety of factors, including anatomy, soft tissue mobility, biomechanics (movement quality), and physical activity can contribute to a higher risk of patellofemoral syndrome. For example…

  • The anatomical resting position of the patella may be slightly higher than normal, known as “patella-alta”, which can make the patella more susceptible to gradual wear-and-tear.
  • A patella that is hyper-mobile, or has too much mobility, can bump and rub against the underlying bone, irritating the cartilage and causing pain. Conversely, a patella that is hypomobile, or restricted in its mobility, may become painful from having too much force through a certain portion of the patella. 
  • In terms of movement, the patella moves over the femur, but the femur also moves beneath the patella. Biomechanics of the whole leg must be addressed in order to understand what is happening at the knee. The hip and foot play a significant role in what the knee experiences. For example, someone with excessively pronated feet or weakness in the hip muscles may experience knee pain because of altered mechanics and resulting pressure on the cartilage lining of the patella. Abnormal biomechanics can be corrected through exercise prescribed by a physical therapist. 
  • Physical activity contributes to patellofemoral pain as well. The intensity or load from the activity might be putting more force on the knees than the body is able to safely tolerate. Activity modification may be necessary to get symptoms under control. For example, exercises like running may be avoided for a period of time in order to calm symptoms like swelling and pain.

If contributing factors are not addressed, friction and rubbing between the surfaces can worsen, leading to thinning and fraying of the cartilage, wear-and-tear of the joint, and eventually bone-on-bone osteoarthritis. 

What is the best treatment for Patellofemoral Pain Syndrome?

The recommended treatment for patellofemoral pain is generally focused on strengthening the muscles of the leg, from the hip and core to the foot, along with maintaining or increasing flexibility to reduce strain on the patella. Normalizing strength, flexibility, and biomechanics through the limb will help to reduce pressure on specific parts of the cartilage that have become irritated and painful, allowing activity and exercise to be comfortable again. 

Along with strengthening, ice and anti-inflammatory medications, such as ibuprofen, are often recommended in order to reduce swelling and alleviate pain during the acute phase. Decreasing painful activities like climbing stairs can be helpful in recovering from patellofemoral pain syndrome. While limiting painful exercises, you can still be active by including alternative non-painful exercises that will help strengthen around the knee and reduce irritation of the cartilage and other structures that support the patella. For example, a runner with patellofemoral pain may substitute swimming a couple of times per week to stay active while not aggravating the knee. 

Did I wait too long? Is it too late for me?

No matter how long you have been experiencing knee pain, it’s never too late to start building strength. Focusing on correcting your mechanics while exercising and moving can help to decrease your pain over time. Strengthening the musculature around the knees will help you move with better control and precision, also enhancing performance. Increasing body control allows for more stability in the patellofemoral joint, which can take the stress off the patella and decrease the risk of further breakdown in the cartilage. 

Can it Heal?

Patellofemoral pain syndrome is one of the most common causes of knee pain and one of the most common conditions fixed in physical therapy. A guided exercise program to address the underlying causes is the best treatment strategy to alleviate patellofemoral pain. 

Our courses at ACL Strong are developed and programmed by physical therapists in order to give you the utmost confidence that the exercises you are performing are both safe and effective. 

Many of our members experience an unexpected benefit from enrolling in an ACL Strong course…their patellofemoral pain improved because they started training smarter and taking pressure off their knees. 

“I can’t believe that I’m skiing without pain for the first time in years!”

“The knee pain that I used to have while playing soccer is not there anymore!”

“One of the greatest benefits we’ve seen in our athletes through ACL Strong is that it helps them resolve old injuries that were nagging them.”

When you join the ACL Strong Snow Course or Classic Course, you learn how to take care of your knees long-term so you can be as active or competitive as you want, for as long as you want. 

👉 Start strengthening and training smarter today!

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