Patellofemoral Pain Syndrome

(Runner’s Knee)


Patellofemoral pain syndrome is a condition in which pain is felt under the kneecap. The patella is the bone that makes up the kneecap. The femur is the thigh bone. This bone forms the upper part of the knee. In patellofemoral pain syndrome, the patella rubs painfully against the femur.
This pain occurs during exercise or movement. It is most common during weight bearing activities such as running.
The Kneecap
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The pain is the result of inflammation of soft tissues around the kneecap. It can be due to a number of different factors or conditions, such as overuse and improper use of the legs.

Risk Factors

The following factors increase your chance of developing patellofemoral pain syndrome.


The first symptom is pain around or under the kneecap. The pain may first occur during high-impact activities. As the condition gets worse, the pain may be triggered by squatting, kneeling, or long periods of sitting. It is thought to be caused by the pressure on the kneecap while the leg is flexed. It is often increased by going down stairs or down hills. If you have knee or joint pain during activity, call your doctor.
Other symptoms may include:


You will be asked about your symptoms and medical history. A physical exam will be done. Images may be taken of your knee.
Your doctor may refer you to a specialist. Orthopedic surgeons focus on bone and joint disorders.


The initial step is to rest the knee. High-impact activities should be switched for lower impact exercise. For example, choose swimming instead of running (except breaststroke). Your doctor may suggest that you apply ice to the kneecap after activity.
Longer-term treatment involves a number of different strategies, including:

Physical Therapy

A physical therapist will assess the injury. An exercise program will be created to help recovery and to strengthen the muscles around the knee. This includes the quadriceps muscles in the thigh as well as other muscles near the hip.


Over-the-counter medication may be advised to reduce pain.

External Devices

Some people find relief from knee braces or knee sleeves. These devices typically have a cutout in the kneecap area. They are designed to hold the kneecap in place during activity. Some are designed to hold the patella from going too far laterally.
Certain methods of taping the patella in position may also be helpful.
Special shoe inserts, called orthotics, may also be helpful. They work best when the condition is due to dysfunction in the foot, such as flat feet or excessive pronation.


In rare cases, people who do not respond to other forms of treatment may be recommended for surgery. This will be done to correct mal-alignment of the patella.


It may not be possible to totally prevent this condition. There are steps you can take to reduce your risk and avoid making the condition worse, including:


Family Doctor—American Academy of Family Physicians

OrthoInfo—American Academy of Orthopaedic Surgeons


Canadian Orthopaedic Association

Health Canada


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