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Patellofemoral Pain Syndrome

Forty-two percent of runners experience knee pain, making it the most common injury among runners. Patellofemoral pain is the most common diagnosis of those younger than 50 years old with knee pain.


Pain in the front of the knee that is worse during squatting, lunges, stairs, or sitting for long periods of time (during car rides or at the movie theater). Pain is usually described as a dull ache, and occasionally a sharp pain. At first, knee pain will occur after a run and as the pain worsens it may be prominent during a run. There is not usually a specific injury, but a gradual increase in pain with increased activity. Females have a higher risk for developing patellafemoral pain.


It is thought that pain is caused by bad alignment of the patella (knee cap or the flat triangular bone located at the front of the knee joint), causing an irritation of the undersurface of the knee cap. The top of the patella is smooth, but the undersurface has a vertical ridge running down the middle that corresponds to a valley made by the end of the femur (thigh bone). The patella is housed in the quadriceps tendon – all four quadriceps muscles attach to the patella, and the tendon inserts just below the knee. If the quadriceps are weak, it is likely the patella is not optimally aligned during knee movement. Also, weakness or decreased flexibility at the hips can lead to pain at the knee, because the musculature surrounding the hips and pelvis controls the motion of the femur as well. It is generally accepted that patellofemoral pain is multi-factorial, and not just a result of a single limitation. The following have been identified in research, specifically in those with patellofemoral pain: 1. weakness of the quadriceps, and hip abductors (group of muscles that bring the hip away from midline of the body)

2. Decreased flexibility of the IT band, quadriceps, and hamstrings

3. Poor dynamic control when stepping down (the knee will often move across midline of the body)


This condition is not usually treated with surgery, but with physical therapy (good news, right?). A physical therapist is qualified to assess the specific areas of limitation for each person, and provide a customized program. Alignment will be assessed in static positions and during specific activities as well. Running, walking, going up and down stairs, etc. should be thought of as a composite motion with influences from the abdominals, hips, knee, and ankle/foot; the treatment will also focus on correcting the areas that affect the entire limb.

 Risk Factors:

  • Female
  • Weakness of the quadriceps or hip abductors
  • Novice runners are 2.5-3 times more likely to be injured
  • Rapid increase in mileage or running more than 40 miles/week
  • Ignoring early symptoms of an injury or incomplete recovery from a prior injury

 Non-risk factors (Do Not increase risk of injury)

  • Running surface
  • Foot type: pronated, supinated, neutral
  • Type of running shoe, neither brand or type (stability, motion control); matching foot type to a specific shoe has not been shown to decrease injury rates.


 Risk Factors for Patellofemoral Pain Syndrome: A Systematic Review Lankhourst et al JOSPT (2012).

 Proximal and Distal Influces on Hip and Knee Kinematics in Runners With Patellofemoral Pain During a Prolonged Run, Dierks et al, (2008), 38:8.

 Association of Footwear with Patellofemoral Pain Syndrome in Runners. Cheung et al. (2006) 36:3.

 Patterns of Malalignment, Muscle Activation, Joint Motion, and Patellofemoral Pain Syndrome.  Earl et al. (2005) 14:215-233.



Gillian McGeorge, PT, DPT, ATC
Physical Therapist, Certified Athletic Trainer

Mountain Land Physical Therapy

Gillian joined Mountain Land Physical Therapy after graduating from the University of Utah with her Doctorates of Physical Therapy in 2009. She specializes in sports medicine and general orthopedics including low back pain, neck pain, post-surgical, joint pain and generalized weakness. Gillian also has additional training in amputees working with prosthetics and orthotics as well as neurologically involved patients.

She loves being active. It’s an important part of her life and she understands it’s an important part of others’ as well. Gillian’s reward comes when she can help her patients get back to their previous level of functioning and resume normal living. Travelling, running and hiking are some of the activities that Gillian enjoys as well as playing the violin. She enjoys volunteering with special needs children and loves spending time with her husband and children.

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This entry was posted on Thursday, August 29th, 2013 at 8:16 pm and is filed under Common Running Injuries, Injuries and Pain. You can follow any responses to this entry through the RSS 2.0 feed.

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