Patellofemoral Pain Syndrome

Body Health Blog

As Vancouver's Sports Chiropractor, Armitage & Associates is committed to helping you maximize your performance potential. These articles are provided to help you understand muscle and joint behavior, prevent injury, and aid recover from common activity-related injuries.


Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is the most common diagnosis for knee pain in athletic and nonathletic populations; the incidence may be twice as high in female athletes compared with their male counterparts (Almeida, 1999 and Arendt, 2000).

The PFPS pain syndrome is a combination of diagnoses and generally can be classified into patellar instability, synovial plica syndrome, PFPS with malalignment, and PFPS without malalignment.

This condition manifests itself as pain and/or tenderness beneath the kneecap (patella) or at the sides of the kneecap. It results from the irritation with possible progression to softening or wearing away of the cartilage under the kneecap itself. Inflammation occurs because the kneecap is not riding smoothly over the knee. In severe cases, it is possible to feel and hear grinding as rough cartilage rubs against itself or bone when the knee flexes.

Potential Causes

  • Fatigued or weakness within the divisions of quadriceps muscles can prevent the kneecap from tracking smoothly.
  • A muscle imbalance between the quadriceps and hamstrings (Often the result of pelvic imbalances) can pull the kneecap out of the groove.
  • Excessive foot pronation can cause the patella to move off-line.
  • Training mistakes of increasing mileage too quickly or too much hill running (particularly downhill).


It is not advisable to continue to run with this condition if severe. Mild to moderate cases can be managed with activity modification of reducing mileage, speed and most notably stride length. Regular icing will help reduce the inflammation. Assessment of bio– mechanics from low back to your feet by your health care provider will locate any compounding of ground reaction forces. Depending on the runner’s foot plant, motion control footwear, over the counter (OTC) or custom made orthotics and patellar taping/bracing are ways of reducing over-pronation, if that is the root of the problem. Relative rest to alleviate pain and discomfort. Runners often benefit from switching to low-impact aerobic activities for a defined period of time, such as swimming, aqua aerobics, “elliptical” training, or cycling. Biking may aggravate or increase symptoms, so make sure the bike is properly fit for each individual.

If conservative treatment methods fail, surgery may be needed to remove the rough edges of cartilage that are causing the discomfort. Cortisone injections are not advisable.

Prevention and Rehabilitation

  • Review your running schedule to ensure you are not overtraining.
  • Check to ensure your running shoes are not worn out and that you have appropriate running shoes for your foot type. If this is something you are unsure of, check with your nearest specialist running store.
  • See your sports health care provider to have your running mechanics evaluated, including from low back to the your feet (bring your training shoes).
  • Strengthening and stretching for the quadriceps, hamstrings, gluts and calf muscles.
  • Swimming and pool running are good alternatives to maintain cardiovascular fitness.
  • When returning to running, avoid steep down hills and cambered roads. Plan a gradual increase in training over a four to six week period to get back to your previous level of training and intensity.

Arendt E, Griffin LY. Musculoskeletal injuries. In: Drinkwater BL, editor. Women in sport. Oxford (UK): Blackwell Science; 2000. p. 208–40.

Almeida SA, Trone DW, Leone DM, et al. Gender differences in musculoskeletal injury rates: a function of symptom reporting? Med Sci Sports Exerc 1999;31(12):1807–12.


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