Question 1

Overview of the anatomy

Accepted Answer

The patellofemoral joint is the area between your kneecap and the two bones of your leg that lie beneath it. When it’s injured, a typical pain pattern develops over the front of your knee and around your kneecap. This painful condition is known as patellofemoral pain syndrome.

Question 2

Symptoms of patellofemoral pain syndrome

Accepted Answer

The most common symptoms associated with patellofemoral pain syndrome include:

The pain is located over the front of the knee and is usually difficult to locate. You can feel the pain above, to the side, or below the kneecap.
Walking down stairs or hills is often more painful than walking up.
Deep squats or kneeling may hurt.
There may be a slight puffiness or swelling around the kneecap, but not always.
Your knee may click occasionally click or clunk as you move it from flexion to extension.
You may notice a grinding sensation under the kneecap.
Sitting with your knee in a flexed position for a prolonged period can make it hurt.

Question 3

When to see a doctor

Accepted Answer

You should consult your doctor or physiotherapist before using the app to ensure your diagnosis is correct and your injury is ready to start rehab exercises.

If you have any concerns about your injury after you've started your rehab, schedule a review with your doctor, particularly if:

Your knee is very painful, swollen, red, or hot to touch, indicating an inflammatory condition not covered by the app.
You experience pain at night that keeps you awake or interrupts your sleep.
You feel pins and needles or tingling in your leg that might indicate a nerve injury and require special treatment.
Your symptoms get worse.
Your injury takes longer to heal than expected (see healing timeframes in the following section).

Question 4

Causes of a patellofemoral pain syndrome

Accepted Answer

The leading cause of patellofemoral joint pain is overloading it. Overload can be caused by:

There is a sudden increase in (high-impact) activities such as downhill running, squats, jumping, or running long distances.
Weakness in your core and hip muscles can cause your knee to turn in more when you run. In turn, this can strain your patellofemoral joint.
If your foot rolls in (over-pronates) too much, it can cause your knee to turn in excessively and strain it. Usually, this results from weak ankle muscles or wearing unsupportive shoes.
Weak quadriceps (front thigh) muscles may also contribute to it.

Question 5

Rehab, recovery times & prevention

Accepted Answer

Rehab

The exercise-based rehab plan for patellofemoral pain syndrome consists of 3 main stages:

First, you have to reduce the pain and allow the joint to settle by reducing aggravating activities and using ice when necessary.
Then, you have to slowly strengthen all the muscles in your core and legs while training optimal movement patterns.
Finally, you can ease back into running while focusing on good running form.

The app’s rehab plan guides you through this process. Because we all heal at different rates, it is essential to progress through the exercise levels and stages at your own pace.

Healing times

In most cases, patellofemoral pain syndrome will recover within 6-12 weeks, but it may take longer if:

You’ve heavily overloaded the joint with an extreme sporting activity,
or you’ve neglected it for a while and trained through the pain.

Prevention

Continue regular strength training for your core, hip, and quad muscles.
Do regular balance and proprioception exercises.
Avoid increasing your running intensity or volume too quickly.

Question 6

Research References

Accepted Answer

Brukner, P., Khan, K., & Brukner, P. (2018). Brukner & Khan’s clinical sports medicine. Sydney: McGraw-Hill.
Collins, N. J., et al. (2018). “2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017.” Br J Sports Med 52(18): 1170-1178.
Crossley KM. Is patellofemoral osteoarthritis a common sequela of patellofemoral pain? Br J Sports Med. 2014 Mar;48(6):409-10. doi: 10.1136/bjsports-2014-093445. PMID: 24569144.
Lack, S., et al. (2018). “How to manage patellofemoral pain – Understanding the multifactorial nature and treatment options.” Physical Therapy in Sport 32: 155-166.
Neal, B. S. (2019). The influence of lower limb biomechanics on the development, persistence and management of patellofemoral pain in recreational runners, Queen Mary University of London.

Strong Knees: Patellar Stability