Patellofemoral pain is pain at the front of the knee, around or behind the kneecap, where it runs against the thigh bone. You may also hear it called runner's knee, or chondromalacia patellae when the cartilage on the back of the kneecap is irritated. It is one of the most common knee problems in active adults, and it is very treatable.

What it feels like

• A dull ache around or behind the kneecap, hard to point to with one finger
• Worse going down stairs or downhill, often more than going up
• Worse after sitting with the knee bent for a long time
• Worse with squatting, kneeling, running or cycling
• Grinding or creaking as you bend the knee, which on its own is not a cause for concern
• Often both knees, though one is usually worse

Common causes

• A rapid increase in training, running volume, or time on stairs and hills
• Weakness in the hip muscles that control how the thigh rotates when you land
• Weakness or poor timing in the quadriceps
• Tightness in the quadriceps, hamstrings or calf
• How the kneecap tracks in its groove, which is affected by the hip and the foot as well as the knee
• Returning to activity too quickly after a period of rest or injury

How physiotherapy helps

The international consensus on patellofemoral pain recommends exercise therapy combining hip-focused and knee-focused work, in preference to knee exercises alone. The practical reason is that how the hip controls the leg determines how the kneecap is loaded. Treatment commonly includes:

• A combined hip and knee strengthening programme, which is the core of treatment
• Managing load through the kneecap joint — how far the knee bends under load matters, and is opened up by stages
• Manual therapy and soft tissue work to the quadriceps, hip and calf
• Retraining how you squat, land and run so the knee is loaded differently
• Taping or bracing for short-term relief while the strengthening takes effect
• A graded return to running, stairs or sport rather than a single return date

What to expect at your first visit

Your physiotherapist takes a history, examines the knee, tests hip and thigh strength, and watches how you squat, step down and walk. The knee is often where the pain is felt and not where the problem starts, so the hip and foot are assessed too. They will explain what they have found and agree a plan with you. Most people begin treatment in the same appointment.

When to see a doctor instead

See your physician or go to an urgent care clinic if the knee gave way and swelled within hours, if it locks or catches so that you cannot straighten it, if you cannot put weight on it after an injury, or if the joint is hot, red and swollen with fever.

Booking an appointment

You do not need a doctor’s referral to see a physiotherapist in Ontario. Some extended health plans ask for one before they will reimburse you, so it is worth checking your policy.

We are at 2600 Skymark Avenue, Building 3, Unit 102, Mississauga, open Monday to Friday 9:00 AM – 10:00 PM and Saturday and Sunday 9:00 AM – 7:00 PM, with free parking. See our fees or call 647-998-4727.

Get directions

This page is general information, not medical advice. An assessment with a registered physiotherapist is the way to find out what is causing your symptoms and what will help.