Patellofemoral (PFP) Knee Pain

Do you have knee pain when walking, running, Squatting or up the stairs? You may be experiencing some patellofemoral pain (PFP). This is when there is pain felt on the front of the knee, surrounding or behind your knee cap or patella.

What is it?

The patellofemoral joint is an important part of the knee where it acts as a pulley system to help the quadriceps muscles straighten the knee. There are ligaments and muscles surrounding the patella that helps it move smoothly on the femur or thigh bone.

PFP is a common clinical presentation to physiotherapy. It can affect people of all ages, however it has been shown to affect up to one third of adolescents.


There are a variety of causes for PFP and while every presentation may differ, the most common things we see are:

  • weakness to the front thigh muscle (quadriceps)
  • weakness to the buttock/hip muscles ( gluteals)
  • variation in bony anatomy of the hip, knee or foot

Any or all of these can impact how the patella moves when you bend or straighten your knee. This creates extra friction to the tissues around the knee, poor alignment of the leg and knee or excessive tightness of muscles surrounding.

How can physiotherapy help?

It is important to have a thorough assessment with your physiotherapist to diagnose the condition and the underlying factors which may have caused your pain.

  • Education: this is extremely important to help you be actively involved in your rehabilitation, understand recovery time and how to manage/modify your activity levels.
  • Exercise: you will be given a tailored exercise program to help improve your muscle strength, movement patterns and muscle control of the lower limb (hip and knee). There is strong evidence regarding strength of the quadriceps and gluteals in PFP.
  • Taping: this can provide you with great relief in the short term to help manage the painful symptoms and assist you in participating in your rehabilitation program
  • Manual therapy: massage and joint mobilisation can help to reduced excessive tightness in the surrounding muscles.

There is a large amount of research evidence to support the use of physiotherapy. According to the International Patellofemoral research group:

  • Exercise therapy has been shown to reduce PFP and improve knee function in the short term (less than 6 months) and in the long term (greater than 12 months)
  • A combination of hip and knee exercises have demonstrated better effectiveness than just knee exercises alone
  • Physiotherapy consisting of a combination of methods is recommended to reduce PFP in the short and long term.

If you have knee pain, be sure to reach out to your physiotherapist to get you back on track!