Patellofemoral pain syndrome: 6 reasons your knee hurts and what may help

Knee pain around or behind your kneecap can make stairs, squats, running and even sitting uncomfortable. Patellofemoral pain syndrome is one possible explanation, but knee pain can come from several conditions. A physical therapist can assess your symptoms, movement and activity demands to help identify what may be contributing to your pain and build a plan that fits your goals.

What is patellofemoral pain syndrome?

Patellofemoral pain syndrome, sometimes called runner’s knee, describes pain around or behind the kneecap. The pain often shows up during activities that load the knee while it bends, such as running, squatting, climbing stairs or sitting for a long time with the knee bent. It may develop gradually rather than after one clear injury.

This condition is not the only cause of pain at the front of the knee. Tendon problems, arthritis, bursitis and other conditions can cause similar symptoms. An evaluation can help distinguish patellofemoral pain from other possible sources of knee pain.

6 reasons patellofemoral pain may develop or flare up

Patellofemoral pain is often influenced by more than one factor. The exact mix can differ from person to person. These six factors may contribute to symptoms or make an existing problem more noticeable:

1. A sudden increase in activity

A fast jump in running mileage, hill training, jumping, squatting or other knee-loading activity can increase stress around the kneecap. Your tissues may need time to adapt to a new training load. This does not mean activity is harmful, but the amount or intensity may need to be adjusted for a period of time.

2. Reduced hip or knee strength

The muscles around your hips and knees help control how your leg handles force during walking, running and other activities. If some of these muscles are not strong enough for your current demands, the knee may become more sensitive during repeated loading. Exercise programs that target both the hip and knee are commonly recommended for patellofemoral pain in clinical practice guidance.

3. Changes in movement control

How your hip, knee, foot and trunk move together can affect how force is distributed through the leg. Some people with patellofemoral pain show movement patterns that may change how load is distributed around the kneecap during tasks such as squatting or running. A physical therapist may watch how you move and decide whether movement retraining could be useful.

4. Repetitive knee bending under load

Activities that repeatedly bend the knee while supporting body weight can bring on symptoms. Common examples include stairs, lunges, deep squats and running. The issue is not always the activity itself. Symptoms may be related to how much load the knee is handling, how often the activity is repeated and whether recovery time is adequate.

5. Running or sports demands that exceed current capacity

Patellofemoral pain can occur in runners and athletes, but it can also affect people who are less active. In sports, changes in speed work, practice frequency, terrain or competition demands may expose a gap between what the knee can currently tolerate and what the activity requires. Training changes are usually considered alongside strength, movement and symptom response.

6. Individual factors that change knee loading

Foot mechanics, flexibility, joint mobility and the shape of the leg or kneecap may influence symptoms in some people. These factors do not automatically cause patellofemoral pain. A clinician can help determine which findings are meaningful for you instead of treating every difference as a problem.

What may help with patellofemoral pain syndrome?

Treatment should match the person rather than follow one routine for everyone. Physical therapy often includes education, activity changes and progressive exercise.

Your plan may include:

• Activity modification — Temporarily changing volume, intensity or aggravating movements while keeping you as active as your symptoms allow

• Hip and knee strengthening — Building the capacity of muscles that help manage force during daily activity and sport

• Movement retraining — Practicing strategies for tasks such as running, squatting or climbing stairs when movement patterns appear relevant

• Gradual return to activity — Increasing training demands step by step based on symptoms, function and goals

• Other short-term tools — Taping or foot orthoses may be useful for some people when they are part of a broader exercise-based plan

There is no single exercise, brace or technique that is right for everyone. Your response to movement, your activity goals and your evaluation findings can guide the plan.

When should you have knee pain evaluated?

Consider an evaluation if knee pain is persistent, worsening or limiting your daily activities. It may also be helpful to seek care if symptoms keep returning when you increase activity. Sudden severe pain, major swelling, inability to bear weight, a visibly changed joint shape or other concerning symptoms may require prompt medical attention.

Physical therapists can assess strength, mobility, movement and activity tolerance. They can also help determine whether your symptoms fit a pattern that may respond to physical therapy or whether another health care professional should be involved.

How KC Rehab may help with kneecap pain

If pain around your kneecap is keeping you from running, exercising or moving comfortably, KC Rehab can help you take the next step.

Our physical therapists can evaluate your knee, discuss your goals and build an individualized plan that may include strengthening, movement training and gradual activity progression.

Contact our team today for more information or to schedule an initial appointment.

FAQs about patellofemoral pain syndrome

What does patellofemoral pain syndrome feel like?

It often causes an aching or uncomfortable feeling around or behind the kneecap. Symptoms may become more noticeable during stairs, running, squatting or prolonged sitting, but other knee conditions can cause similar symptoms.

Why does patellofemoral pain hurt when I squat?

Squatting increases the load placed through the knee as it bends. If the area around the kneecap is sensitive, deeper or repeated squats may bring on symptoms.

Can weak hip muscles contribute to patellofemoral pain?

Reduced hip strength may be one contributing factor for some people. Physical therapists often assess both hip and knee strength because the entire leg helps manage force during movement.

Should I stop running if I have kneecap pain?

Not necessarily. Some people may benefit from temporarily changing mileage, speed, hills or training frequency rather than stopping all activity. An individualized evaluation can help guide those changes.

What exercises may help patellofemoral pain syndrome?

Hip and knee strengthening exercises are commonly included in evidence-informed physical therapy plans. The right exercises and resistance levels depend on your symptoms, strength and activity goals.

Is patellofemoral pain syndrome the same as arthritis?

No. Patellofemoral pain syndrome and arthritis are different conditions, although both can cause discomfort around the kneecap. An evaluation may help determine which condition better fits your symptoms.

Can patellofemoral pain syndrome happen if I am not a runner?

Yes. Although it is sometimes called runner’s knee, patellofemoral pain can affect people with many different activity levels.

How is patellofemoral pain syndrome diagnosed?

A health care professional usually considers your symptoms, medical history and physical examination. They may evaluate strength, mobility and movement and determine whether other conditions need to be ruled out.

Do I need imaging for pain around my kneecap?

Not everyone with kneecap pain needs imaging. A clinician can determine whether an X-ray, MRI or another test may be useful based on your symptoms and examination findings.

When should I see a physical therapist for knee pain?

Consider physical therapy if pain persists, worsens, keeps returning or limits activities that matter to you. A physical therapist can evaluate possible contributing factors and help determine appropriate next steps.