Clinical Notes : Orthopedics and Trauma

60. Patellofemoral Pain Syndrome


Patello-femoral Pain Syndrome (PFPS)

also known as anterior knee pain

in the absence of pathology such as dysplasia, instability or arthrosis


PFPS affects the kneecap and surrounding area.

Don’t confuse it with iliotibial band syndrome (ITBS) which affects primarily the outside of the knee (the lateral or outward-facing side of the knee).

  • Etiology

    • Overuse

    • Injury,

    • Excess weight,

    • A kneecap that is not properly aligned (patellar tracking disorder)

      • most commonly presenting with lateral patellar shift to the lateral side, due to abductor muscles (outer thigh) being stronger than adductor muscles

  • Presentation

    • Gradual onset diffuse anterior knee pain behind or around the patella

    • Often with crepitus or grinding sensation

    • Aggravated by

      • sitting with bent knees (e.g. in car)

      • ascending/descending stairs

      • squatting

      • jumping

  • Very common

    • 11-17% of all knee presentations in general practice

    • It frequently occurs in teenagers, manual laborers, and athletes.

    • Over half of cases bilateral, commonly caused by overuse and excess weight

      • the unilateral cases are commonly caused by injury or patellar tracking disorder

  • Diagnosis is clinical

    • anterior knee pain elicited in a squatting manoeuvre is very sensitive

    • immediate pain relief from decompression of soft tissues proximal to the patella is highly suggestive

  • Most cases resolve conservatively

    • NSAIDs

    • exercise therapy/ physiotherapy

      • strengthen adductors (inner thigh)

      • stretch abductors (outer thigh)

    • patellar taping to control the position of the patella and correct tracking alignment


Exercise to strengthen adductors (inner thigh)


Sit in a chair, leaning slightly forward, arms at sides, feet flat on the floor.

Place a medium-size ball between your legs above your knees, with just enough pressure to hold the ball in place.

Squeeze the ball with your inner-thigh muscles. Then release just enough to hold the ball in place.

Start with 10 squeezes; work up to 30.

Repeat this excercise every morning and evening.


Exercise to stretch abductors (outer thigh)


Stand upright and cross your right leg behind your left.

Lean slightly forwards and to your left side until you feel a stretch on the outside of your right leg.

Lean on a chair/wall if needed.

Hold for 30 secs and repeat 3 times

Repeat this excercise every morning and evening.

Note :

Immediate pain relief


is frequently brought about by decompression of the soft tissue above the patella

achieved by pressure from the thumb as demonstrated in the adjacent picture.

BMJ Best Practice.png

Save Yourself from Patellofemoral Pain Syndrome

Paul Ingraham

Pain Vancouver, Canada Updated May 21, 2017 (first published 2003)


Associates of Physical Function and Pain in Patients with Patellofemoral Pain Syndrome

Sara R. Piva et al

Arch Phys Med Rehabil. 2009 Feb; 90(2): 285–295.



Patellofemoral Pain Syndrome: A Review and Guidelines for Treatment

Mark S, Juhn DO

Am Fam Physician. 1999 Nov 1;60(7):2012-22.


Hip abductor weakness is not the cause for iliotibial band syndrome.

Grau S et al

Int J Sports Med. 2008 Jul;29(7):579-83.



Patellofemoral Pain Syndrome

BMJ Best Practice

Last reviewed: February 2019

Last updated: March  2018


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