Patellofemoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome (PFPS) is the one of the most common causes of anterior knee pain. PFPS is characterised by poor tracking of the knee cap (patella) through its groove in the thigh bone (femur) causes friction and shearing of the underneath side of the patella on either side of the femoral groove.


There are many biomechanical factors that can cause poor patella tracking, both from around the knee joint, and remotely at the hip, ankle and foot.

The Hip

  • Weakness of the hip abductors and external rotators such as the Gluteus Medius and Minimus, reduces hip stability and can cause your knee to roll inwards, thus placing extra strain on the lateral knee structures such as the Iliotibial Band (ITB) and Vastus Lateralis. This causes asymmetry at the knee joint and impairs tracking of the patella

The Knee

  • Asymmetrical strength between the inner and outer Quadricep muscles i.e. Vastus Medialis and Vastus Lateralis, also causes patella maltracking. Commonly the Vastus Lateralis and ITB are stronger and tighter, whilst the Vastus Medialis is weaker and often atrophied from impaired use. This causes more tension on the lateral side of the patella and less on the medial side, pulling the patella outward when contracting the quadriceps and shearing the underneath side of the patella on the lateral femoral condyle. This asymmetry however is usually not the primary cause, rather a compensation from abnormal hip biomechanics as described above.

The Ankle and Foot

  • Flat feet or pronated feet/ankles cause the knee to drift inwards relative to the hip. This inwards drift causes compensatory tightness and increased outward pull by the ITB and lateral quad muscle. Overall this causes poor tracking of the patella. Inversely, if the foot is too arched/supinated, the foot’s shock absorbing ability becomes compromised, placing extra force through the knee which can cause abnormal patella tracking or pain.

Common Symptoms

  • Pain behind the knee cap
  • Knee crackling or crunching when squatting
  • Aggravated by stairs, squatting, kneeling, jumping and running
  • Movie-goers sign: knee aching when sitting down in a chair for extended periods

Pain Management

PFPS can be managed by a Physiotherapist at Bodyworks. This would include hands-on manual therapy such as dry needling and massage to release tight musculature that may be causing patella tracking issues. Mobilisations to the patella can also be used to improve its multi-directional movement. Exercises will be prescribed and progressed in a graded-manner to address the biomechanical faults that would be causing the patella tracking faults. Rehabilitation sessions at Bodyworks can also be very helpful to improve hip, knee and foot biomechanics in a guided and tailored approach.

If you are experiencing knee pain that isn’t getting better, and want a streamlined and thorough rehabilitation, please don’t hesitate to give Bodyworks a call on 9381 5565 to discuss more or book in for a treatment session.


Petersen, W., Ellermann, A., Gösele-Koppenburg, A., Best, R., Rembitzki, I. V., Brüggemann, G., & Liebau, C. (2014). Patellofemoral pain syndrome. Knee Surgery, Sports Traumatology, Arthroscopy, 22(10), 2264-2274. doi:10.1007/s00167-013-2759-6

Lankhorst, N. E., Bierma-Zeinstra, S. M. A., & van Middelkoop, M. (2013). Factors associated with patellofemoral pain syndrome: A systematic review. British Journal of Sports Medicine, 47(4), 193-206. doi:10.1136/bjsports-2011-090369

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