Exercises to Reduce Knee Swelling

Patellofemoral Pain Syndrome Symptoms Explained


Medically reviewed by Misty Seidenburg

Patellofemoral pain syndrome is pain located under and around the kneecap. Also known as “runner’s knee” this condition affects people of all ages and abilities—not just runners. In this blog, we will explore the causes, symptoms, and treatments available for patellofemoral pain syndrome symptoms to help you feel better and get moving again without knee pain.

Knee Joint Anatomy

The knee is among the most complex joints in the human body. It is formed by the lower end of the thighbone (femur), the upper end of the shinbone (tibia), the calf bone (fibula), and the kneecap (patella.) Tendons and ligaments connect the bones to the muscles and act likes ropes to hold the bones together.

Several structures support healthy knee function. The patella rests in a small ridge located at the end of the thighbone. This is called the trochlear groove. As you bend and straighten your knee, the patella moves smoothly within this groove.

Slippery cartilage cushions the end of the knee bones and helps the them slide easily when the leg moves. Another tissue called synovium covers the surfaces of the knee joint and produces fluid to lubricate the cartilage. A small pad of fat underneath the patella acts as a shock absorber during movement.

What Causes Patellofemoral Pain?

It’s probably clear from this glimpse into the anatomy of the knee how many working parts have to function as designed to allow for proper, pain-free bending and extending of the knee and leg.

Injuries, anatomical differences, and systemic diseases can all disrupt proper knee function and contribute to the discomfort associated with patellofemoral pain syndrome.

Runner’s knee can be caused by:

  • Cartilage breakdown: degeneration of cartilage under the patella (chondromalacia patella) forces it to rub against the thigh bone causing pain and swelling
  • Improper form: poor form or training technique can increase force on different parts of the knee causing pain and inflammation
  • Injuries: a direct hit to the knee or surrounding structures from a fall, contact sport, or impact with another person or object
  • Misalignment: certain alignment differences in any of the bones from the hip to the ankle can shift the kneecap too far to either side of the leg increasing the risk of dislocation
  • Muscle imbalance or weakness: weak or imbalanced hip and thigh muscles (glutes and quadriceps) cannot keep the kneecap in proper position in the trochlear groove
  • Overuse: running, jumping, squatting, climbing steps, and other vigorous activities can place repeated stress on the knees

Also, a sudden increase in activity that is too much load for your body’s capacity  can exacerbate symptoms or increase the risk of developing patellofemoral pain syndrome. The condition is more common in women, high-intensity athletes, and adolescents and young adults.

Patellofemoral Pain Syndrome Symptoms

Dull, aching pain in the front of the knee is an early indicator of patellofemoral pain syndrome. It typically comes on gradually and worsens with activities that involve bending the knee. Sitting for long periods of time can make pain worse.

Sports and activities that require lots of bending also tend to aggravate patella pain. Some people notice their pain worse after starting a new training regimen or increasing the intensity of exercise and other activities. Cracking and popping sounds when bending the knee are also commonly associated with patellofemoral pain syndrome.

Patellofemoral Pain Syndrome Treatments

Runner’s knee often improves with conservative treatments including home care, exercise, and stretching. Surgery is reserved for patients who don’t respond to noninvasive therapies.

Patellofemoral Pain Syndrome Self-Care and Home Remedies

The emerging school of thought supports the P.E.A.C.E. and L.O.V.E. protocol for healing soft tissue injuries like patellofemoral pain syndrome. This approach is a revision of previous the incarnations of the I.C.E. and R.I.C.E. acronyms widely-used for the rehabilitation of soft tissue injuries.


P.E.A.C.E. and L.O.V.E. was created to better address the subacute and chronic stages of recovery for better long-term outcomes. The most notable changes include guidance on avoiding icing and anti-inflammatory medications. While both options may offer mild, immediate improvement, research suggests they can potentially interrupt the inflammation process and impair tissue repair.

Physical Therapy for Runner’s Knee

If symptoms don’t improve after a few days to a week of home care, physical therapy may be the answer. Holistic physical therapy addresses multiple issues that may be causing your pain.

Physical therapy for patellofemoral pain syndrome includes:

  • Exercise: Safe and effective patellofemoral pain syndrome exercises strengthen the leg muscles that support healthy knee joint function.
  • Movement and gait training: Proper alignment for all of the activities that fill your day can reduce patella dysfunction and pain.
  • Manual therapy: Hands-on techniques help to improve pain, function, and range of motion for healthy, happy knees.

Physical therapists also have a wealth of information to share with patients. Learn how simple changes like choosing the right footwear or wearing a patellofemoral pain syndrome brace can reduce your symptoms and prevent knee pain from recurring.

If you are one of the nearly 25% of the global population who experiences chronic knee pain, you don’t have to suffer any longer. Physical therapy can provide real and lasting relief from runner’s knee without surgery or the need for long-term pain medication.

To schedule your knee pain evaluation, find a physical therapy clinic near you.

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Medically reviewed by

Misty Seidenburg

Vice President of Clinical Programs

Dr. Misty Seidenburg has been a practicing physical therapist since 2006 after obtaining her Doctor of Physical Therapy Degree from Gannon University. Dr. Seidenburg completed an Orthopedic Residency in 2009 and subsequent Spine Fellowship in 2010 where she discovered a passion for educating clinicians. Since 2019, she has developed and refined several post-professional residency and fellowship programs and currently serves as the Vice President of Clinical Programs for Upstream Rehab Institute. She serves on several APTA committees to help advance the profession, is adjunct faculty at Messiah University, and is also a senior instructor and course developer for the Institute of Advanced Musculoskeletal Treatments with a special interest in exercise integration. Outside of work, she enjoys challenging herself with new adventures and is currently competing as an endurance athlete.

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