Common Symptoms of Patellofemoral Pain

You may have patellofemoral pain if you experience:

• Pain at the front of the knee

• Pain behind or around the kneecap

• Pain with stairs (especially descending)

• Pain with squatting or lunging

• Pain after prolonged sitting (“movie theatre sign”)

• Pain during or after running

• Stiffness after cycling

Symptoms are typically load-related rather than traumatic.

 

What Causes Patellofemoral Pain?

Modern research shows patellofemoral pain is primarily a load-management and tissue capacity problem, not simply a “tracking issue.”

 

Current consensus guidelines highlight:

1. Load–Capacity Mismatch

When training load exceeds the patellofemoral joint’s tolerance:

• Sudden mileage increases

• Increased hill running

• Increased cycling intensity

• Rapid gym progression

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2. Strength & Capacity Deficits

Evidence consistently supports deficits in:

• Quadriceps strength

• Hip abductor strength

• Hip external rotator strength

Reduced strength increases patellofemoral joint stress during functional tasks.

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3. Biomechanical Contributors

May include:

• Excessive dynamic knee valgus

• Increased femoral internal rotation

• Step rate and stride length factors

• Poor cycling setup (in cyclists)

Importantly, patella “maltracking” alone is rarely the primary driver.

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How Is Patellofemoral Pain Diagnosed?

Diagnosis is clinical and based on:

• Anterior knee pain reproduced with loading

• Pain with squatting

• Pain with stairs

• Pain with resisted knee extension

Imaging (MRI/X-ray) is usually unnecessary unless symptoms are atypical.

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Evidence-Based Treatment for Patellofemoral Pain

Current international best practice (Patellofemoral Pain Clinical Practice Guidelines) strongly supports:

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1. Exercise Therapy (Primary Treatment)

The cornerstone of management is progressive strengthening.

Programs include:

• Quadriceps strengthening

• Hip abductor strengthening

• Hip external rotator strengthening

• Progressive functional loading

• Plyometrics when appropriate

Exercise therapy has the strongest evidence for both short and long-term outcomes.

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2. Load Management

We adjust:

• Running volume

• Cycling load

• Gym intensity

• Plyometric exposure

The goal is to reduce pain while maintaining fitness.

Complete rest is rarely required.

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3. Running & Cycling Modifications

For runners:

• Increasing cadence by 5–7% can reduce patellofemoral joint stress

• Temporary reduction in downhill running

For cyclists:

• Saddle height optimisation

• Cleat position review

• Load progression strategies

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⚠️ What Is NOT Supported by Strong Evidence

• Passive-only treatment (massage alone)

• Isolated VMO activation

• Routine bracing without exercise

• “Fixing” patella alignment alone

Manual therapy may assist short term, but exercise therapy drives recovery.

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How Long Does Patellofemoral Pain Take to Improve?

With structured rehabilitation:

• Early improvement: 4–6 weeks

• Significant improvement: 8–12 weeks

• Full performance return: criteria-based

Symptoms often improve before full capacity is restored — which is why structured progression matters.

 

Why Patellofemoral Pain Becomes Persistent

Research shows persistent PFP is associated with:

• Inadequate load progression

• Poor adherence to strengthening

• Fear-avoidance behaviour

• Early return without criteria

This is why generic exercise sheets often fail.

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Frequently Asked Questions

Can I keep running with patellofemoral pain?

Often yes, within a pain-monitoring model and adjusted load framework.

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Do I need an MRI?

Usually no. PFP is diagnosed clinically.

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Will I need surgery?

Surgery is rarely indicated for true patellofemoral pain.

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Does taping help?

Taping may provide short-term symptom relief but should not replace exercise therapy.

 

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Book Patellofemoral Pain Treatment Today.

If you’re experiencing front-of-knee pain while running, cycling or training, early structured rehab improves long-term outcomes.

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Omnia Physio – Potts Point, Sydney
Specialising in running and endurance injuries.

Book online today.