Patellofemoral knee pain

Understanding patellofemoral knee pain

Patellofemoral knee pain is pain around or behind the patella, aggravated by activities that increase load on the patella femoral joint (PFJ), e.g. squatting, ascending and descending stairs, prolonged sitting and running. There could be multiple factors contributing to the knee pain, some of them being:

poor function and weakness of the hip muscles
poor function and weakness of the thigh muscles
too much foot roll (pronation)
anxiety, depression, and widespread pain could contribute to increased sensitivity of symptoms

The best management for the symptoms entails a structured exercise session, with the use of taping and foot orthotics if your physiotherapist deems this appropriate.

Once symptoms become less irritable in day-to-day functions, your physiotherapist can refer you to our Rehabilitation Instructor for further rehabilitation, depending on your goals

How much exercise should I do?

A senior couple on yoga mats outside in a park in a bent knee standing pose with arms outstretched.

Exercise 2 -3 times a week

Allowing enough rest is important to let soft tissues recover and develop.

cropped image of two people, one black and one while in shorts and t-shirts on an exercise bike pedalling. Close crop on their hands on handle bars and their legs moving.

Choose 3 or 4 exercises

Choose exercises that are challenging but manageable.

Young asian man running on the spot wearing a t-shirt and shorts in their living room on a wooden floor.

Repeat the exercise

Perform 8-12 repetitions of each exercise.

Rest

Rest for up to 1 to 2 minutes between each set.

Once an exercise is easy, progress it

Increase the number of repetitions or hold the positions for longer for a more challenging exercise. Try and avoid high-impact activities and excessive forces being put through the knee.

How much pain is too much pain?

Before exercising

Before exercising, rate your pain at the moment on a scale of 0 to 10, where 0 is no pain and 10 is the worst pain you can imagine.

A maximum pain level

A maximum pain level of 4/10 whilst exercising is fine as long as it eases within 45 minutes of the session and does not interfere with sleep or activities the next day.

If your pain increases

If your pain increases beyond this, simplify the exercise by reducing the range of movement or number of repetitions, or try an easier exercise.

Supportive exercises

To manage the pain, monitor pain levels during and after exercise. Experts frequently recommend that if patients have a large increase in pain, or pain stays increased for more than 24 hours after exercise, they may be doing ‘too much, too soon’.

Bridge with hip external rotation

Chair squat with hip external rotation

Stand tall with your feet approximately hip-width apart and weight distributed evenly between your feet. The loop of the exercise band is placed around your legs under your knees, and the slack is taken off.
Make sure the chair is at a suitable distance behind you. Bend your knees and hips and squat down.

At the same time rotate your knees outwards against the resistance. The knees and toes should point in the same direction. Lightly sit down and then push back up to the starting position using your thighs and buttock muscles.

Ankle position during squat

Start in a standing with your feet hip-width apart and a mini band around both feet close to your ankles. Feel how the band pulls your feet into pronation/roll in.

Press the ball joints of the big toes against the floor and roll your feet outwards to raise the inner arch of the foot. Keep this position in your feet and do a squatting movement.

Note: Keep your toes relaxed during this exercise.

Lunge, alignment

Stand in a split stance position with an exercise band around your front leg (under or above the knee) and attached firmly to the side so that the band pulls your knee inwards - this is the movement you are trying to resist.

Squat down and push back up. Consciously activate your buttock muscles to keep hip, knee and toes aligned.

Note: The shin of the front leg stays upright.

Single leg chair squat

Anterior step down

Single leg bridge

Squat with mini band around legs

Start by standing with a mini band around your knees (slightly above or under). Your legs are approximately hip-width apart or slightly wider and toes are pointing forwards or slightly outwards. Arms can be crossed over the chest or placed on your hips or they can move along with the squat.

Squat down, move your hips back and bend your legs. Press your knees outwards against the resistance from the band to keep toes, ankles, knees and hips aligned. Feel the tension in your thighs and buttocks. Push back up to standing and straighten your knees and hips.

Need more help?

Consider self referring using the link below:

If you have a new injury or problem, please look at the self help information in our advice pages. We will often complete the same exercises and share information in clinic appointments.

If you still need some more help you can self refer into our service. Please note that the NHS is currently experiencing longer than normal waits, for more information visit our waiting times page.

Refer yourself to physiotherapy