Demystifying Patellofemoral Joint Pain

Source: Peak Physio

What Is PFPS?

The Patellofemoral Joint (PFJ) is the joint between the patella (kneecap) and femur (thigh bone). We often refer to pain coming from this joint as Patellofemoral Pain Syndrome (PFPS). PFPS is a very common cause of pain coming from the front of the knee, affecting about 10% of beginner runners and 22.7% of the general population. Specific populations, such as adolescents and elite athletes, are likely to experience even higher rates. Females are twice as likely to experience PFPS as males.

How Long Does PFPS Last?

Recovery timeframes for PFPS can vary. Relief of symptoms may be rapid, but, on average, it takes about 3 months. However, it is not unusual for PFPS to be persistent, with some studies finding that up to 40% of those with PFPS continue to experience symptoms after 2 years.

Load vs Capacity: A Key Contributor

PFPS often develops when your load (what you’re asking your knee to do) exceeds your capacity (what your knee can handle). That means if you suddenly increase your running distance, speed, or hills, your knees may not keep up. It is important to avoid big changes or increases in load by using gradual progression to give your joints time to adapt. To put this into context, a 2025 study looking at safe load progression in adult runners found significantly increased running-related injury rates with a greater than 10% increase in running distance compared to the longest run completed in the previous 30 days.

How Much Load Does the PFJ Experience?

PFJ loading levels also vary significantly across exercises and activities. Peak loading ranges from 0.6 times body weight during walking, 5.4 times body weight during running and up to 8.2 times body weight during a single leg decline squat. This research gives us a useful blueprint for how to progress or regress exercises for the knee, with manipulation of variables such as squat depth, double leg vs single leg versions, step height, and gradient, all increasing or decreasing PFJ load.

The Role of Hip Strength and Biomechanics

Weak hip muscles, particularly those that move the leg outward (hip abductors), can contribute to poor knee alignment during movement known as “dynamic knee valgus”, where the knee collapses inward when running or landing. Strengthening the hips and thighs and improving movement control may be important to address this.

Evidence-Based Management of PFPS

Recent best practice guidelines recommend a multifaceted approach to managing PFPS, including:

• Education about pain, load management and gradual load progression.

• Exercise targeting glutes, quads, and movement control.

• Taping or orthoses may be helpful

• Running technique modifications such as increasing cadence (step rate) or reducing overstriding can reduce PFJ load.

  
  

What About Noisy Knees?

Many patients with PFPS present with, or report ‘noisy’ knees. The technical name for this grinding, creaking or popping is Crepitus. Studies have shown that Crepitus is not associated with negative impacts on function, activity level and pain. Crepitus is also commonly present in those without pain. It is not considered a sign that you are doing damage.

Final Thoughts

PFPS is a common but complex condition. It may be influenced by a variety of factors, including how your whole system manages load, movement, and mindset. With the right combination of load management, strength, gradual progression and education, most people can get back to moving and living without fear or pain.

This article is for informational purposes only and does not constitute medical advice; always consult a qualified healthcare provider for personalised care.

For all your health and rehabilitation needs, check out Peak Physio in Newcastle, Rutherford and Budgewoi.

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